Reimbursement for clinical services provided by ambulatory care pharmacists via telehealth

ABSTRACT

Introduction: Data specific to pharmacists' value in patient-provided clinical services in New York are limited due to their scope of practice restrictions. However, due to the coronavirus disease 2019 (COVID-19) pandemic, there has been an expansion of telehealth and allowance for billable services for pharmacists. Objectives: The objective of this study was to complete a retrospective review to assess reimbursement of clinical services provided by pharmacists via telehealth during the pandemic in a primary care setting. Methods: A report was generated which identified patients 18 years and older, who were provided services by pharmacists within a primary care group via telehealth during March to July 2020 in New York. It identified patients with an appointment type code of “PharmD Telemed 30” or “PharmD TM Follow UP 15,” including Medicare Annual Wellness Visits or AWVs (G0438-G0439) with procedural codes, and incident-to CPT codes (99211-99214). Information received included medical record number, name, date of birth, carrier plan name, billed procedure code and description, carrier payment amount, and patient responsible amount. Results: A total of 485 patients were provided services during the timeframe. There were 223 encounters billed for the 99 211 CPT code, 156 of which received payment from insurers with an average of $20.14. For initial and subsequent AWVs there were a total of 48 and 150 encounters, respectively, billed by the pharmacists. Forty-one of the encounters billed as a G0438 received payment from insurers with an average of $175.75. One hundred thirty-three of the encounters billed as a G0439 received payment from insurers with an average payment of $114.09. Conclusion: The results of this study provided insight into whether specific services or insurances should be targeted for payment of services. Expansion of these services could show improvement in patient care and can assist in gathering outcomes to better support pharmacists gaining provider status on the state and national level.