HOPE Center Study Warns Against Reliance on CPT Codes to Identify MTM Services in Administrative Claims

(November 20, 2020)

College of Pharmacy and HOPE Center investigators David Rhys Axon, PhD, MPharm, MS and Terri Warholak, PhD, RPh co-authored a study recently published in the Journal of Managed Care & Specialty Pharmacy. This was a retrospective cohort study titled Current procedural terminology (CPT) codes for medication therapy management (MTM) in administrative data. The study included data from 16,483,709 patients in the Medicare Part D dataset to assess the number of patients receiving MTM services using CTP codes, and found an overall prevalence of 0.020% were receiving the service. It was not possible to identify all patients in receipt of MTM services, thus, use of CPT codes to identify MTM services in administrative claims is not recommended. The study raises awareness of the number of Medicare Part D patients receiving the benefit of the offered MTM service as well as the need for more accurate methodologies to determine overall MTM prevalence.

The research team also includes College of Pharmacy Health & Pharmaceutical Outcomes Program alumni Chanadda Chinthammit, BPharm, MS, PhD, and Patrick Campbell, PhD, PharmD, RPH along with colleagues Jared Tate, PharmD, Ann Taylor MPH, MCHES, Sandra Leal, PharmD, MPH, FAPhA, Matthew Pickering, PharmD, and Heather Black, PhD.