Medication Therapy Management (MTM): Reducing Polypharmacy Risks in Older Adults

Approximately 30% of older adults in the U.S. are currently using five or more medications daily, also known as polypharmacy, which increases the risk of medication errors, hospitalization, and preventable adverse drug events. The management of complex medication regimens is among the most significant challenges in modern-day clinician practice.

Structured Medication Therapy Management (MTM) programs have become an essential component of healthcare, reducing polypharmacy and enhancing clinical outcomes by optimizing treatment regimens and implementing Digital Healthcare Solutions that support documentation, billing, and workflow processes.

As healthcare transitions to value-based care, MTM has become a necessary and valuable service offered by physicians, care coordinators, and pharmacists to improve patient safety and create meaningful reimbursement opportunities for clinical interventions.

What is Medication Therapy Management (MTM)?

Medication Therapy Management (MTM) is a patient-centered, clinician-led service intended to provide individuals with the necessary oversight of their medications to achieve the best therapeutic result. It’s a provider-based approach for maximizing the use of medications.

MTM programs are more comprehensive than just performing a medication review. Online MTM services play an active role in assessing medications, reconciling medications, identifying risks, and developing a patient-specific action plan based on the patient’s unique situation. It also assists providers in identifying potential medication interactions, managing dosage adjustments, discontinuing unnecessary medications, and improving adherence to therapy.

What Makes MTM a Modern Way to Provide Healthcare

MTM reduces clinical risk, increases efficiency by allowing providers to streamline their decision-making, and ensures that patients have the safest and most effective medication regimen possible when it comes to their medications.

Digital MTM platforms support this by allowing for better tracking of clinicians’ progress, documentation of medications, and coordination between care teams. It helps in reducing the growing burden from polypharmacy.

How MTM Reduces the Complexity and Risk of Taking Multiple Medications

Older adults often have multiple chronic conditions; therefore are often prescribed multiple medications, which can sometimes lead to taking more than is medically appropriate because of differing prescribers, pharmacies, and specialists’ orders, with no oversight. The result is that patients are placed at risk of cognitive decline, increased risk of falls, kidney damage, and adverse drug interactions.

MTM allows healthcare providers to review and evaluate medications in a structured way. This allows for the removal of unnecessary or redundant medications, the creation of a comprehensive medication plan, and a better understanding of the implications for patients. These steps reduce the overall number of pills prescribed, decrease pill burden, reduce the risk of adverse drug interactions, and improve the overall safety and continuity of care.

Eligibility Requirements for MTM Services

Knowing the eligibility criteria assists providers in identifying the most suitable individuals for MTM services and complying with Medicare guidelines. To be eligible for the MTM program under Medicare Part D, a beneficiary must meet the following criteria:

• Have 2 or more chronic conditions
• Take multiple medications classified under Part D
• Have a high probability of side effects from the medications they take

The above qualifications ensure providers focus on patients at the highest risk for therapeutic errors. MTM services are frequently part of the provider’s approach when participating in value-based systems such as RPM or CCM, allowing patients to receive the benefits of MTM along with other chronic disease management services.

Important MTM Billing Codes for Healthcare Providers

Ensuring compliance with MTM billing is important to increase revenue opportunities. The primary MTM CPT codes for billing services offered by providers include:

• 99605: 15 minutes for a new patient
• 99606: 15 minutes for an established patient
• 99607: Each additional 15 minutes spent on an MTM service

These codes enable structured reimbursement for medication review and care planning. Providers can better manage MTM billing workflows using electronic documentation and time tracking. Using a platform like HealthArc, providers can integrate billing systems with payer documentation requirements with no risk of inaccuracies.

The Core Components of a Successful MTM Program

Having a consistent structure, documentation, and follow-up is essential for a successful MTM program that includes:

• Comprehensive Medication Review (CMR): A Comprehensive Medication Review (CMR) includes a full review of all medications a patient is taking, including prescriptions, over-the-counter products, vitamins, and supplements. The clinician identifies issues with therapy and includes a patient-specific action plan.
• Targeted Medication Review (TMR): A Targeted Medication Review (TMR) allows clinicians to follow particular issues such as adherence, high-risk medications, dosing errors, or changes to the patient’s medication list. Ongoing TMR ensures medication safety and effectiveness year-round.
• Medication Action Plan (MAP): HealthArc’s MTM assists healthcare professionals in creating a personalized medication action plan that includes actionable, patient-specific steps to ensure optimal medication use, while achieving individual health goals.

Medication Therapy Management and Polypharmacy Risks in the Elderly

MTM directly helps providers prevent drug-related complications as they are increasingly accountable for avoiding:

• Adverse Drug Events and Harmful Drug Interactions: The older adult population metabolizes medications differently, increasing risks for toxicities. Through MTM, providers identify medication interactions and contraindications based on specific conditions.
• Duplicated Treatment and Unnecessary Interventions: Multiple providers may inadvertently prescribe medications with overlapping mechanisms of action, causing duplicative therapy. MTM assists in eliminating duplication and supports safe medication prescribing practices.

The Value of MTM to Providers, Physicians, and Other Clinicians

MTM offers significant value to clinicians and healthcare delivery systems by ensuring:

• Improvement in Patient Safety and Outcomes: It decreases medication errors, increases adherence, and improves outcomes for chronic disease management, collectively helping reduce hospitalizations.
• Increase in Clinical Revenue: When providers use MTM billing codes along with RPM, CCM, and TCM, they create additional revenue streams, enhance regulatory compliance, and improve patient satisfaction.
• Enhanced Care Coordination: Clinicians gain clarity regarding pharmacotherapy needs. MTM documentation promotes care coordination between primary care physicians, specialists, pharmacists, and care teams.

Digital MTM Platforms Build Strong Clinical Workflows

With advancing technology, digital MTM platforms make MTM efficient and scalable rather than burdensome.

• Automated Documentation & Structured Reporting: HealthArc automates MTM activities such as medication reviews, time tracking, action plans, and communication, reducing administrative burden and ensuring “audit-ready” reporting.
• Integration of RPM, CCM & LTC Services: A unified digital ecosystem integrating MTM, RPM, CCM, and long-term care ensures coordinated care efforts, better outcomes, and real-time insight into patient vitals and medication changes.
• Improved Engagement and Adherence Tools: Digital reminders, medication directions, and communication features empower patients to follow treatment regimens and prevent misunderstandings, especially among older adults.

MTM services have become increasingly necessary to reduce polypharmacy risks among the elderly. The complexity of medication regimens requires MTM to identify medication therapy risks early, streamline regimens, and provide individualized oversight. Using standardized processes, billing codes, and advanced technology enables providers to expand MTM delivery, improve safety, and enhance clinical efficiency.

Frequently Asked Questions about Medication Therapy Management (MTM)

About HealthArc’s Medication Therapy Management Services

HealthArc is one of the leading digital health platforms in the U.S., providing an integrated approach to managing and billing Medication Therapy Management (MTM), Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Remote Therapeutic Monitoring (RTM), Transitional Care Management (TCM), Advanced Primary Care Management (APCM), and Principal Care Management (PCM) services for providers.

Our platform enables clinicians to automate documentation, streamline billing, simplify workflow management, and improve patient engagement, all within one comprehensive unified system.

Need help with MTM services? Feel free to schedule a demo or call us at +201 885 5571 now for information on MTM billing and eligibility.