Getting Paid for Clinical Services: 5 Tips for Pharmacists

For pharmacists who want to be delegated as medical providers and get reimbursed for their clinical services, working with the legal systems of each state can be really frustrating. Expansion of scope of practice and decreasing revenues from distribution are requiring pharmacists to increasingly embrace clinical care services into their practices. Pharmacists should be able to receive payment in order for the provision of clinical care to be sustainable.

Reimbursement tips

  1. Use established CPT/ ICD-10 codes when billing for medical provider services.
  2. Track and measure the outcomes of the services you provide.
  3. Sign up with the database service of National Council for Prescription Drug Programs (NCPDP) which permits a pharmacy to the bill.
  4. Pharmacists must use the latest pharmacy billing software – QS1.
  5. Obtain a National Provider Identifier number if the billing for clinical services has to be done via a physician’s office.


  • Pharmacists who are billing for patients should remember to use their NPI number for service documentation and claim forms.
  • To describe pharmacists’ patient care services, Medication therapy management services (MTMS) codes (99605, 99606, and 99607) were developed in regards.
  • It is indispensable to recognize and confirm whether the payer will pay for the services before the services or procedures are provided.

MBCs role in maximizing Pharmacy revenues

MBC’s pharmacy medical billing and coding services would not just help you accurately discern which type of treatment comes under injectable or adjuvant therapies, but also take care of the entire range of your admin activities from claim preparation through submission to post-submission follow-ups.

Our Team of Experts have a complete working knowledge of

  • CPT codes and coding guidelines
  • Documentation for drug category review
  • Maintaining your non-clinical paperwork letting you spend more time on drug dispensing.
  • Awareness of all compliance audits and standards, thereby reducing the coding errors.
  • Creation of tailor-made statistical and analytical reports for the clients