OAR 410-121-0190
Medication Therapy Management Services and Clozapine Therapy Monitoring

(1)

Clozapine monitoring protocol requires enhanced record keeping and reporting to the drug manufacturer’s registry in order to dispense the medication. Dispensing pharmacy must meet all drug manufacturers requirements including data reporting.

(2)

Clozapine monitoring includes documentation of client’s diagnosis, dosage, dosage changes, appropriate laboratory reports (e.g. white blood cell counts), evaluation intervals, and submission of appropriate information to drug manufacturer to allow dispensing of medication;

(3)

Clozapine monitoring is to be billed using appropriate Medication Therapy Management Services (MTMS) Current Procedural Terminology (CPT) code with the modifier TC appended. This is limited to no more than 5 units in 30 day time period per client, including the 30 day period from the date of discontinuation of clozapine therapy;

(4)

Clozapine monitoring must be billed by a pharmacy;

(5)

MTMS rendered outside of clozapine management must be performed by a licensed pharmacist and must be billed to appropriately reflect the performing provider. These encounters must be billed using the appropriate MTMS CPT code without the TC modifier.

Source: Rule 410-121-0190 — Medication Therapy Management Services and Clozapine Therapy Monitoring, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-121-0190.

410‑121‑0000
Foreword and Definition of Terms 410‑121‑0021
Organizations Authorized to Provide Pharmaceutical Prescription Services 410‑121‑0030
Practitioner-Managed Prescription Drug Plan 410‑121‑0032
Supplemental Rebate Agreements 410‑121‑0033
Polypharmacy Profiling 410‑121‑0040
Prior Authorization Required for Drugs and Products 410‑121‑0060
How to Get Prior Authorization for Drugs 410‑121‑0061
Durable Medical Equipment, Medical Supplies, and Medical Surgical Services (Physician Administered Drugs) 410‑121‑0100
Drug Use Review 410‑121‑0111
Pharmacy and Therapeutics Committee 410‑121‑0135
Pharmacy Management Program 410‑121‑0143
Client Confidentiality 410‑121‑0145
Prescription Requirements 410‑121‑0146
Dispensing Limitations 410‑121‑0147
Exclusions and Limitations 410‑121‑0148
Dispensing in a Nursing Facility or Community Based Care Living Facility 410‑121‑0150
Billing Requirements 410‑121‑0155
Reimbursement 410‑121‑0157
Participation in the Medicaid Drug Rebate Program 410‑121‑0160
Dispensing Fees 410‑121‑0185
Pharmacy Based Immunization Delivery 410‑121‑0190
Medication Therapy Management Services and Clozapine Therapy Monitoring 410‑121‑0200
Billing Forms 410‑121‑0220
Instructions for Completion of the Prescription Drug Invoice 410‑121‑0280
Billing Quantities, Metric Quantities and Package Sizes 410‑121‑0300
CMS Federal Upper Limits for Drug Payments 410‑121‑0420
DESI Less-Than-Effective Drug List 410‑121‑0580
Oregon Medicaid and Pharmaceutical Manufacturers’ Dispute Resolution Procedures 410‑121‑0625
Items Covered in the All-Inclusive Rate for Nursing Facilities
Last Updated

Jun. 8, 2021

Rule 410-121-0190’s source at or​.us