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The Ultimate CPT and ICD-10 Code Guide for Pharmacists

All the Essential Codes Pharmacists Need In 2024

By James Lott, PharmD

LAST UPDATED 05/16/2024

All your pharmacist code questions, answered.

  • This page provides guidance for pharmacies on using appropriate CPT and ICD-10 codes to ensure accurate and timely medical claims submissions.

  • Reference essential CPT codes for services such as immunizations, comprehensive medication reviews, medication therapy management, acute care visits, point-of-care testing, and health screenings.

  • We’ll also highlight the importance of correctly applying codes. They play a vital role in maximizing reimbursement, allowing pharmacists to streamline billing processes and optimize patient care services within the pharmacy setting.

  • Pharmacists will find practical insights into code selection for specific services, including examples, descriptions, and the associated ICD-10 codes. This resource is designed to support pharmacies in navigating the complexities of medical coding for various patient care offerings.

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#   ESSENTIAL CPT AND ICD-10 CODES FOR PHARMACISTS

#   ICD-10 CODES

#   IMMUNIZATION CPT CODES

#   MEDICATION THERAPY MANAGEMENT CPT CODES

#   ACUTE VISITS AND SERVICES CPT CODES

#   POINT OF CARE TESTING AND HEALTH SCREENING CODES

#   AUTOMATIC CODE MANAGEMENT FOR PHARMACISTS

Essential CPT and ICD-10 Codes for Pharmacists

ServiceCPT CodeICD-10 Code RangeDescription
Immunizations90460 – 90474Z23Immunization administration for vaccines/toxoids. Community pharmacists may use these codes when providing vaccinations to patients.

You’ll generally find CPT codes for common immunizations (i.e. COVID-19 or influenza) in this range — we’d love to provide a specific itemized list for each one, but the specific code will vary depending on the health plan to which you’re submitting as well as the region you’re in. Administration vs. the medication itself may also be a factor.

If you need help finding the specific CPT code for your vaccine, region, and health plan, we can help for free: just drop us a line. 
Comprehensive Medication ReviewsVarious E/M codesVariousPharmacists may use Evaluation and Management (E/M) codes, such as 99213 or 99214, for comprehensive medication reviews. Relevant ICD-10 codes should align with the patient’s condition.
Medication Therapy Management99605, 99606No specific ICD-10 code is requiredCPT codes 99605 and 99606 are used for medication therapy management services provided by pharmacists. These codes reflect face-to-face patient encounters.
Acute Care Visits and Services99202, 99212VariousPharmacists engaging in acute care visits, test to treat, vaccines, smoking cessation, Pep, and Prep services may use E/M codes such as 99202 and 99212. These codes reflect comprehensive assessments and management during patient encounters.
Point-of-Care TestingVariesVariousWhile not strictly CPT codes, pharmacists may use specific codes or identifiers for point-of-care testing services, depending on the type of test performed.
Health ScreeningsVariesVariousDepending on the specific health screening service offered, pharmacists may use relevant CPT codes for billing purposes. Common codes vary based on the screening type.
Social Determinants of Health (SDOH)VariesVariousSocial determinants of health are conditions that may impact people’s well-being and quality of life. Pharmacists may assist in closing gaps in resources.

This page is part of Mastering Pharmacy Medical Billing + Claims Submission.

We’re dedicated to providing the most useful free resource on the Web for pharmacists looking to bring medical billing and claims to their businesses.

Have more questions? We’ve got answers.

Read the full Mastering Pharmacy Medical Billing + Claims Submission guide

ICD-10 Codes

Z23 (Immunization administration):

This code is typically used for documenting immunization services. Pharmacists can include this ICD-10 code when billing for immunization administration.


No specific ICD-10 code required Medication Therapy Management. Specific ICD-10 codes may not be required for these services in many cases. However, it’s essential to adhere to any payer-specific requirements.


Various ICD-10 codes (Acute Care Visits and Services): The selection of ICD-10 codes will depend on the specific diagnosis or condition addressed during the acute care visit. Pharmacists should document the relevant diagnosis code that justifies the service provided.

CPT Codes

Immunizations (CPT Codes 90460 – 90474):

Community pharmacists play a vital role in public health by administering vaccinations. Pharmacists use CPT codes 90460 through 90474 to facilitate billing for these services and ICD-10 code Z23. These codes cover the administration of vaccines and toxoids, allowing pharmacists to accurately document and bill for immunization services provided to patients.

 

Medication Therapy Management (CPT Codes 99605, 99606):

As part of their commitment to optimizing patient medication regimens, community pharmacists may offer Medication Therapy Management (MTM) services. CPT codes 99605 and 99606 are instrumental in this process, representing face-to-face encounters for the initial and subsequent 15-minute increments, respectively. These codes ensure proper reimbursement for the pharmacist’s time spent conducting comprehensive medication reviews and educating patients on effective medication use.

 

Acute Care Visits and Services (CPT Codes 99202, 99212):

Pharmacists engaged in acute care visits, providing services such as test to treat, vaccines, smoking cessation, Pep, and Prep, may utilize Evaluation and Management (E/M) codes such as 99202 and 99212. These codes reflect the comprehensive assessments and management provided by pharmacists during patient encounters. Pharmacists should adhere to documentation guidelines and billing practices outlined by payers and regulatory authorities. Select ICD-10 codes based on the specific diagnosis addressed.

 

Point-of-Care Testing and Health Screenings

While not strictly governed by CPT codes, point-of-care testing and health screenings are increasingly common in community pharmacies. Pharmacists may use specific codes or identifiers associated with the type of test performed to facilitate billing. Whether it’s rapid strep tests or cholesterol screenings, these codes help streamline the reimbursement process and support the integration of additional patient care services within the pharmacy setting.

WRAPPING UP:

Scripted manages all these codes for pharmacists automatically.

Scripted is a game-changer in the pharmacy billing landscape, offering a comprehensive solution to streamline the process and enhance revenue capture.

Scripted’s user-friendly interface simplifies claim submission, reduces coding errors, and automates claim follow-up, freeing pharmacists to focus on patient care.

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