Billing Resources

Step-by-step instructions on how to register and get paid for your clinical services

Pharmacy Clinical Services Billing: Where to Start

  • Interested in exploring opportunities for pharmacy clinical services billing? You’re in the right place to build your billing plan! 

    For more information, subscribe to the Pharmacy Practice Standards Institute for access to an in-depth billing guide and many other resources.

    1. Consider your stakeholders, payer mix, credentialing plan, documentation strategy, and record retention.

    2. Align your pharmacy clinical services plan with your organizational mission, vision, and obtain review by legal counsel.

    1. Reflect on practice authority, benefits, patient enrollment, claim route, and records.

    2. Formulate your pharmacy clinical services billing plan, assigning roles and responsibilities at each step to capture the full revenue management cycle.

    • Operationalize your plan

    • Elements of a billing claim include HCPCS codes +/- modifiers, ICD-10 codes, NPI or TIN, and place of service

      • The what, why, who, and where 

      • Billing code library 

      • Medical decision making 

      • Payer-specific considerations

        • Iowa Medicaid 

        • Medicare

          • Incident-to billing 

          • Policies and practices by place of service

            • Transitional care management 

            • Chronic care management, complex care management 

            • Principal care management 

            • Remote physiologic management 

            • Advanced primary care management 

            • Additional revenue generating opportunities 

            • Medication therapy management 

            • Annual wellness visit 

            • Diabetes

              • DSME 

              • MDPP 

          • Federally Qualified Health Centers vs Rural Health Clinics 

          • Value Based Payment Models  

        • Commercial Insurance Plans

    • Identify and track metrics to justify and grow

      • Patient outcomes 

      • Financial

      • Practice & organization

Iowa Controlled Substances Act Registration

  • 🔗 Iowa DIAL: CSA Registration

    • Fees: $90/2 years

    • The following documents may be required:

      • Any disciplinary action taken against your professional license in any jurisdiction

      • Any final disciplinary orders in any jurisdiction

      • Last year’s Federal Income Tax Return

      • Certificate of Release or Discharge from Active Duty

      • Verification of Military Experience and Training

      • Any documentation of criminal convictions and court records related to prescription drugs, controlled substances, healthcare, or the practice of your profession in any jurisdiction

      • Approved research protocols (if applicable)

    • Review the Iowa Administrative Code

      • 481 Iowa Administrative Code Chapter 553: Controlled and Precursor Substances

      • 481 Iowa Administrative Code Chapter 556: Iowa Prescription Monitoring Program

    • Once you are approved, you will have the status of “Pending PMP,” and then you can register for your DEA number.

  • 🔗 DEA: Registration Applications, Tools and Resources

    • Fees: $888/3 years

    • Documents required for DEA form 224:

      • State license number and expiration date

      • State controlled license number and expiration date

      • Steps:

        • Click “New Applications”

        • Select your Business Category 

          • Choose “Mid Level Practitioner (NP, PA, OD, etc.)” 

        • Select One Business Activity 

          • Chose “MLP-Registered Pharmacist” for individual registration

        • Complete application

  • 🔗 Iowa PMP: Register for an Account

    • Required for all individual prescribers (except veterinarians or researchers)

    • Once you receive your Iowa CSA and DEA numbers, you can register for the PMP.

      • If you already have an account, ensure your account is updated from “Pharmacist” to “Pharmacist with Prescribing Authority” 

    • Once registered with the PMP, your CSA status will be switched to “Current/Active” and you may begin administering, dispensing, or prescribing controlled substances.  

    • Reminder: PMP account access is limited to a single provider; it is not to be shared. Please sign up with your personal or work email, and do not use anyone else’s email.