Get Pharmacy Accreditation Exemption Statement - Cms

CPT codes 99605 and 99606 are used for medication therapy management services provided by pharmacists. These codes reflect face-to-face patient encounters. Pharmacists 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.

Medicare Part B has limitations on pharmacy billing. There are two “Specialty codes” that may be used by pharmacies, each with limitations. Specialty 73 is for “Mass Immunization Roster Billers” and Specialty A5 (formerly Specialty 87) is for “Pharmacy”.

Medicare Part B (Medical Insurance) includes limited drug coverage. It doesn't cover most drugs you get at the pharmacy.

To offer patients DMEPOS, suppliers must 1) meet program and quality standards, 2) get AO-approved accreditation, and 3) enroll in Medicare. The accreditation may take up to 9 months and consists of three stages.

For Medicare patients, pharmacists are not recognized as Medicare Part B providers and can only bill “incident-to” the physician supervising in the practice or clinic. Consequently, pharmacists are restricted to billing at the 99211 code level.

Accreditation by an AO is voluntary and is not required for Medicare certification or participation in the Medicare Program. A provider's or supplier's ability to bill Medicare for covered services is not impacted if it chooses to discontinue accreditation from a CMS-approved AO or change AOs.

We can bill Medicare Part B and your qualified supplemental insurance, which means little or no out of pocket cost to you.

Dear Pharmacy Benefit Managers, Medicare Part D Plans, Medicaid Managed Care Plans, and Private Insurance Plans: The Centers for Medicare & Medicaid Services (CMS) values your partnership in providing health care coverage and access to essential treatments, including prescription medications, to millions of people.