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See a sample rate comparisonCPT 99607 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Mtms By Pharm Addl 15 Min, Medication Therapy Management Service S Provided By A Pharmacist Individual Face To Face With Patient With Assessment And Intervention If Provided Each Additional 15 Minutes List Separately In Addition To Code For Primary Service
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Medication Therapy Management Services |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 95 - Telemedicine - audio and video 93 - Telemedicine - audio only |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99607 |
| Medicaid Fee Schedule | $24.77 median of the 8 states in the free preview · View Medicaid rates for 99607 |
National average reimbursement for CPT 99607 by major payers:
$31.69
$50.36
$45.91
$71.52
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CPT 99607
2 of 2 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateRam Balasubramanian
$68.73Published rate
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See a sample payer proposalCPT 99607 vs. Other Medication Therapy Management Services Codes
The CPT 99607 code is part of the Medicine Services and Procedures services used for Medication Therapy Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99607 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99600-CPT | Moderate | Home Visit Service, A Visit Or Treatment In The Home By A Health Care Professional. |
| 99605-CPT | Low | Medication Therapy Management, Medication Therapy Management Service(S) Provided By A Pharmacist Individual Face-To-Face With Patient With Assessment And Intervention If Provided Initial 15 Minutes New Patient |
| 99606-CPT | Low | Mtms By Pharm Est 15 Min, Medication Therapy Management Service S Provided By A Pharmacist Individual Face To Face With Patient With Assessment And Intervention If Provided Initial 15 Minutes Established Patient |
| 99607-CPT | Low | Mtms By Pharm Addl 15 Min, Medication Therapy Management Service S Provided By A Pharmacist Individual Face To Face With Patient With Assessment And Intervention If Provided Each Additional 15 Minutes List Separately In Addition To Code For Primary Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99607. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99607 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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