Prescription drug management clarifications from NGS Medicare Contractor (Jurisdiction K for Part B providers in the states of New York, Connecticut, Massachusetts, Rhode Island, Vermont, Maine, and New Hampshire.)

The new 2021 E/M Medical Decision Making table has raised many questions as to what prescription drug management consists of. To know more, read along!


There are many questions as to what prescription drug management consists of in the new 2021 E/M Medical Decision Making table. The quick answer is that the concept of prescription drug management has not changed from what it was previously. To count prescription drug management, there must be:

  • A prescription drug that the practitioner is evaluating the appropriateness of using for the patient; and/or continuing to prescribe for the patient.
  • Documentation on the prescription drug(s) that are being considered and the reason why they are being considered.
  • Documentation of a practitioner’s decision to discontinue a prescription drug or to adjust the current dosage relative to changes in a patient’s condition.
  • The patient condition, possible adverse effects, potential benefits, etc. of the patient using this prescription drug.

Simply stating in the medical record that the physician renewed a prescription for a patient does not meet the risk criteria in the Medical Decision Making table, nor does it warrant an E/M service on its own.

Please remember that prescription drug management is based on the documented evidence in the record showing the provider has evaluated medications during the E/M service as it relates to the patient. Simply listing medications that a patient takes is not prescription drug management. Credit will be provided for prescription drug management as long as the documentation clearly shows that decision-making took place in regard to those medications.