MTM Software & Services
Medication Therapy Management Software and Services
HealthArc gives physicians, pharmacists and care teams the software and clinical support to run complete MTM programs, from patient enrolment and comprehensive medication review to action planning, documentation and CPT billing.
Built for practices managing patients on multiple chronic medications, HealthArc’s MTM platform helps reduce adverse drug events, improve adherence and generate reimbursable MTM encounters under Medicare Part D and commercial plans.
HIPAA Compliant
AICPA SOC 2 Type II
PPCP-aligned workflows
Primary care, cardiology, pharmacy, FQHCs & ACOs
PMR + MAPauto-generated, patient-ready
MTM CPT codesReal-time interaction required
99605Initial MTM encounter, new patient (15 min)$40–50
99606MTM encounter, established patient (15 min)$25–35
99607Each additional 15 minutes (add-on)$15–25
DeliverablesPersonal Medication Record + Action PlanRequired
20–35%reported reduction in preventable ADEs (published MTM research)
$1,200+reported annual drug cost savings per high-risk patient
3MTM CPT codes
2–4 wkstypical time to go live
Program Overview
What Is Medication Therapy Management (MTM)?
Medication Therapy Management (MTM) is a structured, patient-centred service in which qualified clinicians (typically pharmacists working in collaboration with physicians) evaluate a patient’s complete medication regimen, identify drug-related problems and create an individualised plan to optimise therapy and improve health outcomes.
MTM was established as a covered benefit under the Medicare Modernization Act of 2003, which required Medicare Part D plans to offer MTM programs to high-risk beneficiaries. CMS defines eligible patients as those with multiple chronic conditions, taking multiple Part D drugs, and at risk of incurring high drug costs. MTM is distinct from standard medication counselling: counselling addresses individual prescriptions at the point of dispensing, while MTM is a comprehensive review of the patient’s entire medication profile (prescriptions, over-the-counter drugs, vitamins and supplements) with documented clinical findings and a patient-facing action plan.
The two core MTM service types are the Comprehensive Medication Review (CMR) and the Targeted Medication Review (TMR). A CMR is an interactive, real-time consultation (in person or by telehealth) that produces a written Personal Medication Record (PMR) and a Medication Action Plan (MAP) delivered to the patient. A TMR is a between-visit review of the medication profile, often triggered by a clinical event, that doesn’t require real-time interaction but still produces documented recommendations for the prescribing provider.
MTM programs have demonstrated measurable clinical and financial impact. Studies published in the Journal of the American Pharmacists Association have reported reductions in adverse drug events of 20–35% and medication cost savings averaging around $1,200 per patient per year in high-risk populations.
Established by
The Medicare Modernization Act of 2003: MTM is a Part D plan requirement
CMR
Interactive, real-time review producing a PMR and MAP for the patient
TMR
Asynchronous, event-triggered review producing recommendations for the prescriber
Who delivers it
Pharmacists and qualified clinicians in collaboration with the prescribing physician
CPT codes
99605 · 99606 · 99607: see the full MTM code reference
CMS requirement
Enrolled Part D MTM patients must receive at least one CMR per year
CMR or TMR? A CMR is the annual, interactive, billable event that produces the patient’s Personal Medication Record and Medication Action Plan. A TMR is the between-visit review triggered by a new diagnosis, a hospitalisation or a significant lab change. A well-run program uses both. One CMR a year satisfies the CMS requirement; the TMRs are what catch the problem in month seven.
Who It’s For
Who HealthArc’s MTM Platform Is Built For
Built for healthcare organisations that want to run reimbursable, scalable medication management programs without assembling the infrastructure from scratch.
Practice Types & Specialties
- Primary care and internal medicine managing multiple chronic conditions
- Cardiology and endocrinology with high-volume polypharmacy patients
- FQHCs and Rural Health Clinics expanding pharmacy-based care
- ACOs and value-based care groups targeting medication cost and quality metrics
- Health systems and hospital outpatient departments running pharmacist-led MTM
- Independent and clinical pharmacists needing a documentation and billing platform
Patient Populations
- Medicare Part D beneficiaries meeting CMS MTM eligibility
- Medicaid managed care enrollees in states with MTM carve-in benefits
- Commercially insured patients with complex polypharmacy (5+ medications)
- Patients 65+ at higher risk of drug-drug interactions and ADEs
- Patients recently discharged from inpatient settings with reconciliation needs
- Patients with low health literacy or documented non-adherence history
Care Team Roles
- Clinical pharmacists conducting CMR and TMR encounters
- Prescribing physicians and NPs receiving and acting on recommendations
- Care managers coordinating adherence follow-up between reviews
- Quality directors reporting on Star Ratings and HEDIS medication measures
Medicare Part D MTM Eligibility
CMS requires Part D MTM programs to target beneficiaries who meet all three criteria:
- They have two or more chronic diseases from CMS’s approved list, which includes diabetes, heart failure, dyslipidemia, hypertension, COPD, bone disease and arthritis, and mental health conditions
- They are taking multiple Part D covered drugs: a threshold CMS sets annually, typically eight or more
- They are likely to incur annual Part D drug costs above the CMS-established threshold, which is adjusted annually
Medicaid managed care plans and commercial insurers may set different or broader criteria. HealthArc supports configurable eligibility logic so the platform matches any payer’s MTM program enrolment specification rather than forcing one definition on every contract.
The Platform
HealthArc’s MTM Software Platform: Core Features
Every workflow required to run a compliant, billable MTM program in one system: eligibility through encounter, deliverables, adherence follow-up and claim-ready documentation.
Enrolment & Eligibility Management
- Automated patient identification on configurable criteria: condition count, active medication count, payer enrolment status
- Bulk enrolment from EHR panels or manual single-patient enrolment
- Payer-specific MTM program tracking for Part D plans, Medicaid managed care and commercial insurers
- Eligibility re-checks as medication lists and diagnoses change
Comprehensive Medication Review (CMR)
- Structured CMR templates meeting CMS documentation standards
- Real-time pharmacist-patient encounter interface, in person or by integrated telehealth
- Auto-generated Personal Medication Record (PMR) from entered medication data
- Auto-generated Medication Action Plan (MAP) in patient-readable format, delivered digitally or printed
Targeted Medication Review (TMR)
- Asynchronous TMR workflow with clinical trigger documentation: lab change, new diagnosis, recent hospitalisation
- Provider recommendation routing with documented response tracking
- TMR history retained against the patient’s annual program record
- Escalation to a CMR where the review warrants it
Drug Therapy Problem Detection
- Automated flagging of high-risk drug-drug interactions, therapeutic duplications, contraindicated combinations and dose discrepancies
- Alert severity tiering: critical, moderate, low
- Pharmacist override with documented clinical rationale
- Open and resolved problem tracking per patient
Adherence Monitoring & Engagement
- Automated patient reminders by SMS, push notification and portal message
- Adherence tracking by medication and by patient cohort
- Patient portal access to the PMR, MAP and medication schedule
- Non-adherence flags routed to the care team
Provider Collaboration
- Secure in-platform messaging between pharmacist, prescriber and care team
- EHR-connected documentation pushback for completed MTM encounters
- Shared care plan visibility across the multidisciplinary team
- Recommendation acceptance and outcome tracking
Billing & Documentation
- CPT 99605, 99606 and 99607 encounter documentation templates
- Time-stamped session records satisfying payer audit requirements
- Superbill generation and claim-ready documentation export
- Encounter-type auto-selection based on the patient’s MTM history
Reporting & Population Health
- Patient-level and cohort-level adherence, ADE and CMR completion reporting
- Quality measure tracking for HEDIS, CMS Star Ratings and MTM completion metrics
- Exportable reports for payer reporting, internal QI and compliance review
- Scheduled delivery to program leadership
Care Team Model
HealthArc’s MTM Services: What Our Clinical Team Delivers
For practices that need clinical support beyond their existing staff, HealthArc provides a managed MTM service layer. Our care team handles the clinical execution of your program, working as an extension of your practice under your providers’ oversight.
Live CMR Consultations
HealthArc conducts CMR consultations with enrolled patients by phone or video, coordinated against your practice’s schedule.
Pre-Encounter Profile Review
Patient medication profiles are reviewed in advance of each encounter using integrated data from your EHR and pharmacy benefit records.
Documentation & Provider Sign-Off
All CMR and TMR findings are documented in HealthArc and routed as structured summaries to your supervising provider for review and sign-off.
PMR and MAP Creation
Individualised Personal Medication Records and Medication Action Plans, formatted for patient delivery.
Drug Therapy Problem Escalation
Interactions, non-adherence risks and duplications are identified and escalated to your prescribing physician with recommended interventions.
Interim Follow-Up Outreach
Follow-up cadences for patients who need interim monitoring between full CMR cycles, plus documentation audit support if a payer reviews the program.
Option 1
Software only
Your clinical staff run MTM encounters in the platform. Structured templates, auto-generated PMR and MAP, and CPT-mapped documentation come with it.
Best for: practices with internal pharmacy capacity
Option 2
Services only
HealthArc’s pharmacy team manages program execution with your clinical oversight: encounters, deliverables, escalations and documentation.
Best for: practices with no pharmacist on staff
Option 3
Combined
Most clients start here and shift toward software-only as internal pharmacy capacity grows. Scope moves without changing platforms.
Best for: programs ramping toward internal ownership
MTM encounters are documented under the supervising structure appropriate to your state and payer requirements. Physicians and nurse practitioners retain prescriptive authority and clinical decision-making; HealthArc’s pharmacy staff operate within their scope and facilitate the medication review and action planning components.
Billing & Reimbursement
MTM CPT Codes, Documentation Requirements and Reimbursement
MTM services are billed under three CPT codes. Understanding the documentation requirements for each (and how they interact) is what separates a compliant program from a denied claim. HealthArc generates the required documentation during the encounter workflow rather than after it.
$40–50
99605
Initial MTM Encounter: New Patient
- First CMR with a new MTM patient, up to 15 minutes
- Patient consent and full medication list: Rx, OTC and supplements
- At least one drug therapy problem identified
- PMR and MAP generated; interactive real-time interaction required
$25–35
99606
MTM Encounter: Established Patient
- Follow-up CMR with a patient previously seen under 99605
- Updated medication list reflecting changes since the last encounter
- Documented progress on prior MAP action items
- Revised or affirmed PMR and MAP
$15–25
99607
Add-On: Each Additional 15 Minutes
- Billed in addition to 99605 or 99606 when the encounter runs longer
- Continuous time documentation for the full encounter duration
- Each unit requires an incremental 15 minutes of real-time service
- Cannot be billed standalone
Key Compliance Notes
- 99605 requires a real-time, interactive encounter. An asynchronous review of medication records alone doesn’t qualify.
- 99606 requires a prior 99605 on record. It cannot be billed for a first MTM encounter regardless of how long the patient has been with the practice.
- 99607 must accompany a reported 99605 or 99606. There is no unit cap, but audit risk rises without thorough time documentation on encounters beyond 45 minutes.
- Documentation for all three codes: time-stamped encounter record, complete medication list reviewed, identified drug therapy problems, and the generated PMR and MAP.
- Commercial insurers and Medicaid MCOs set their own rates and may add documentation or prior authorisation requirements.
The Monthly Billing Workflow in HealthArc
1
The clinician opens an MTM encounter and selects the patient and encounter type
2
The platform auto-selects the base code (99605 or 99606) from the patient’s encounter history
3
A real-time encounter timer runs during the session and flags the 15-minute threshold
4
If the encounter continues, the platform prompts the clinician to add a 99607 unit
5
On close, a time-stamped, documentation-complete superbill record is generated for export to your billing team or PM system
6
All documentation is retained with an audit trail for payer review
MTM economics come from volume and completion, not rate. The variable worth optimising is the share of your eligible Part D population that completes an annual CMR, which is exactly what the reporting layer tracks.
Calculate Your RevenueReimbursement figures are approximate national non-facility Medicare averages and vary by geographic locality, facility status, payer and calendar year. CMS updates them annually in the Physician Fee Schedule, so don’t treat the numbers here as a quote. Verify current rates at cms.gov or with your MAC before you bill.
Implementation
How HealthArc MTM Implementation Works
Most practices are fully operational within 2–4 weeks. Implementation minimises administrative burden on clinical staff while making sure the program is configured for your patient population and payer mix.
1
Week 1
Discovery & Configuration
An intake call documents your EHR environment, payer contracts (Part D plan partnerships, Medicaid MCOs, commercial plans), panel size and intended staffing model. Platform settings are configured to your eligibility criteria and documentation preferences.
2
Weeks 1–2
EHR Integration
HealthArc connects to your EHR via HL7 FHIR API or direct integration. Demographic and medication data begin flowing into the platform. HealthArc manages the technical connection. Your staff doesn’t.
3
Week 2
Staff Training
Role-based training for clinical staff (pharmacists, care managers), billing staff and supervising providers. Covers encounter workflow, documentation standards per CPT code, patient communication tools and reporting. Around 3–4 hours per user role.
4
Week 3
Pilot Enrolment
A cohort of 20–50 eligible patients is enrolled and the first MTM encounters are conducted under onboarding team observation to validate documentation quality and workflow fit. Billing is reviewed on pilot encounters before full launch.
5
Week 4
Full Program Launch
Full panel enrolment is activated. Automated reminders, adherence monitoring and reporting dashboards go live. Your success manager stays engaged for the first 60 days for optimisation support.
Interoperability
EHR and Health System Integrations
Integration eliminates manual data entry, ensures medication records are current at the time of each encounter, and lets completed encounter documentation flow back into the patient’s medical record automatically.
- HL7 FHIR R4 API: standard across major EHR vendors
- HL7 v2 messaging: for legacy environments
- Direct EHR-specific integrations: for common platforms
- Pharmacy data connections: Part D medication history via Surescripts and equivalent data sources
- Data exchanged: demographics and insurance, active medication list, active diagnosis list and chronic condition flags, labs relevant to pharmacotherapy monitoring (HbA1c, eGFR, INR), and completed encounter documentation and MAP pushed back to the record
Medication History
Part D fill history via Surescripts means the review starts from what the patient actually filled.
Documentation Pushback
Completed encounters and the MAP write back to the patient record, not into a separate silo.
FHIR R4 & HL7 v2
Modern and legacy environments both supported.
BAA Before Data
Executed with every integrated partner before activation.
Commonly Integrated Systems
Epic
Cerner (Oracle Health)
athenahealth
Allscripts / Veradigm
eClinicalWorks
NextGen Healthcare
Greenway Health
DrChrono
Surescripts
Contact HealthArc to confirm integration status for your specific EHR version and environment. All exchange occurs over encrypted, HIPAA-compliant connections, and a BAA is executed with every integrated partner organisation before data activation.
Reporting & Analytics
MTM Reporting, Analytics and Quality Metrics
A real-time view of program performance at patient level, care team level and across the full enrolled population.
Patient-Level Reporting
- Medication adherence rate per patient and per drug
- Open and resolved drug therapy problems with identification and resolution dates
- CMR and TMR completion history with encounter dates and codes billed
- MAP action item status: open, completed, overdue
Program-Level Reporting
- MTM enrolment rate: enrolled versus eligible patients
- CMR completion rate by time period and by care team member
- Drug therapy problem detection rate and category breakdown
- Average medication cost change pre/post intervention where benefit data is available
Quality Measure Tracking
- CMS Star Ratings adherence measures: statin, diabetes medication and RASA adherence
- HEDIS measures relevant to medication management
- MTM program completion rate: a required reporting metric for Part D plan sponsors
- URAC MTM accreditation documentation standards
Exports & Payer Reporting
- CSV, PDF and structured data formats
- Compatible with common practice management and population health platforms
- Payer-specific templates for Part D plan sponsors and Medicaid MCOs
- Scheduled report delivery to program leadership
Compliance & Security
HIPAA Compliance, Data Security and MTM Regulatory Standards
Compliance work that procurement and compliance teams (often the final approvers) will actually ask about.
HIPAA & Data Security
- Full HIPAA compliance with documented PHI handling, access control and breach notification policies
- SOC 2 Type II certified infrastructure
- Encrypted in transit (TLS 1.2+) and at rest (AES-256)
- Role-based access limiting PHI visibility to authorised care team members
- Audit logs for all PHI access events
- BAA executed with provider organisations and integration partners before data activation
MTM Regulatory Compliance
- Documentation templates and encounter workflows structured to meet CMS MTM program guidelines for Part D plan sponsors (42 CFR Part 423, Subpart D)
- CPT billing documentation meeting CMS and commercial payer audit standards for 99605, 99606 and 99607
- Telehealth MTM encounters documented to satisfy CMS requirements for interactive, real-time services
- Payer-specific documentation customisation where contracts demand it
Clinical Standards
- Workflows aligned with the Pharmacists’ Patient Care Process (PPCP) published by the Joint Commission of Pharmacy Practitioners
- MTM service model definitions from the American Pharmacists Association (APhA)
- NACDS Foundation MTM service model alignment
- Structured clinical documentation supporting peer and payer review
Results
MTM Program Results: What the Research Shows
Practices and health systems running structured MTM programs report measurable improvements in medication safety, cost and patient outcomes. The figures below are drawn from published MTM research, attributed, rather than from HealthArc marketing estimates.
20–35%Reduction in preventable ADEs among high-risk polypharmacy patients (Johnson & Bootman; Isetts et al.)
$1,200–1,500Average annual drug cost savings per Part D patient (Malone et al., JAPhA)
10–25%Improvement in medication adherence in chronic disease populations
10–20%Reduction in 30-day readmissions in post-discharge MTM programs
What HealthArc contributes to those numbers is throughput. Structured encounter templates and auto-generated PMR and MAP outputs cut per-encounter documentation time versus manual processes, and CPT-mapped documentation reduces the claim rejections that make MTM programs look unprofitable when they are simply under-documented.
Published outcome ranges are cited from the referenced literature and describe MTM programs generally, not HealthArc customers specifically. Practice-level results from HealthArc programs are shared under NDA during evaluation.
FAQ
Frequently Asked Questions About Medication Therapy Management
The questions practices ask most when evaluating MTM programs and software vendors.
What is medication therapy management software, and how is it different from an EHR?
MTM software is a purpose-built platform for conducting, documenting and billing MTM clinical services: specifically the Comprehensive Medication Review, the Targeted Medication Review and related pharmacist-patient encounters.
It differs from an EHR in being structured around the MTM workflow: eligibility identification, drug therapy problem detection, PMR and MAP generation, CPT-coded encounter documentation and adherence monitoring. EHRs document clinical encounters broadly but don’t natively support the MTM-specific documentation structure CMS and payers require, nor do they generate the patient-facing PMR and MAP deliverables MTM program standards call for. MTM software integrates with your EHR to pull medication and diagnosis data but operates as a specialised layer on top of it.
Who is eligible for medication therapy management services?
Under Medicare Part D, CMS requires MTM programs to target beneficiaries who meet all three of the following: (1) two or more chronic diseases from CMS’s approved list, which includes diabetes, heart failure, dyslipidemia, hypertension, COPD, bone disease and arthritis, and mental health conditions; (2) multiple Part D covered drugs, at a threshold CMS sets annually and typically around eight or more; and (3) likely annual Part D drug costs above the CMS-established threshold, which is adjusted each year.
Medicaid managed care plans and commercial insurers may set different or expanded criteria. HealthArc supports configurable eligibility logic to match any payer’s MTM enrolment specification.
What is the difference between a Comprehensive Medication Review (CMR) and a Targeted Medication Review (TMR)?
A CMR is an interactive, real-time consultation between a pharmacist and a patient (in person or by telehealth) during which the pharmacist reviews all of the patient’s medications (prescription, OTC, vitamins and supplements), identifies drug therapy problems, and delivers a written Personal Medication Record and Medication Action Plan to the patient. A CMR is billed under CPT 99605 (new patient) or 99606 (established patient).
A TMR is an asynchronous, between-visit review of the medication profile, typically triggered by a new diagnosis, hospitalisation or significant lab change. It produces documented recommendations for the prescribing provider. TMRs do not require real-time patient interaction and are not billed under a separate CPT code, but are often part of a Part D plan’s MTM program requirements.
CMS requires that enrolled Part D MTM patients receive at least one CMR per year; additional TMRs are conducted as clinically indicated.
How are MTM services billed, and what documentation is required?
MTM services are billed under three CPT codes. 99605 covers the initial CMR with a new MTM patient (up to 15 minutes, real-time interaction required, generates PMR and MAP). 99606 covers a follow-up CMR with an established MTM patient (up to 15 minutes, requires a prior 99605 on record). 99607 is an add-on billed for each additional 15 minutes alongside either code.
Documentation for all three includes a time-stamped encounter record, the complete medication list reviewed, identified drug therapy problems, and the generated PMR and MAP. Medicare Part D reimbursement ranges from roughly $15 to $50 per unit depending on code and MAC locality; commercial rates vary and some payers require prior authorisation.
Can MTM services be delivered via telehealth?
Yes. CMS has confirmed that MTM CMR encounters qualify for telehealth delivery when conducted as a real-time, interactive audio-video session between pharmacist and patient. The encounter must meet the same documentation and time standards as an in-person CMR.
Audio-only encounters may qualify under certain CMS waivers and state Medicaid policies, but requirements vary. HealthArc supports both in-person and telehealth encounters with a built-in encounter timer, documentation workflow and telehealth session integration. Confirm your specific Part D plan sponsor’s or Medicaid MCO’s telehealth MTM policy, as individual plan requirements may differ from the CMS baseline.
Does private insurance cover medication therapy management?
Coverage under commercial insurance varies significantly by plan and employer. Medicare Part D coverage is mandated by federal law for eligible beneficiaries. Medicaid coverage depends on the state and whether the patient is in a managed care plan that includes MTM as a covered benefit.
Many commercial plans (including large employer-sponsored plans and some ACA marketplace plans ) do cover pharmacist-led MTM, particularly for patients with chronic conditions or high medication costs. Coverage terms, rates and documentation requirements differ by carrier. HealthArc’s implementation team can help identify which payers in your market cover MTM and configure documentation templates accordingly.
What separates HealthArc from other medication therapy management companies?
Most MTM vendors offer either a software platform or a managed clinical service, not both. HealthArc provides an integrated model: use the platform with your own clinical staff, engage HealthArc’s MTM pharmacy team to manage program execution, or run a hybrid.
The platform is built specifically for the MTM encounter workflow: auto-generated PMR and MAP, CPT-coded documentation, EHR integration and payer-specific reporting, and not adapted from a general care management or telehealth tool. HealthArc serves the full range of practice sizes, from independent pharmacist-run MTM practices to multi-site health systems and ACOs.
Get Started
See HealthArc’s MTM Platform in Action
If your practice is evaluating medication therapy management software, building out a new MTM program, or looking for a more efficient path to billing 99605, 99606 and 99607, this is what the platform was built for.
- How the CMR workflow generates a compliant PMR and MAP in real time
- How the platform identifies drug therapy problems from the patient’s medication list
- How CPT-coded documentation is built into the session, not added after the fact
- How reporting surfaces program performance against CMS Star Ratings and quality metrics
- A realistic implementation timeline for your practice size and EHR environment
Schedule a Demo
MTM CPT Code Guide
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Resources
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