10/22/2026

4TH Quarter Billing Buzz from Zone 3

WPS Medicare has just put resources on their website regarding Prescription Drug Management.

OCTOBER BILLING BUZZ FROM Zone 3

WPS Medicare has just put resources on their website regarding Prescription Drug Management.

You can find these resources at https://www.wpsgha.com/guides-resources/view/prescription-drug-management#prescription-drug-management-examples.

On the website the section on Documentation lists the following as items that may be included to satisfy documentation requirements for Prescription Drug Management in physician’s notes.

· Risk to patient from taking the medication

· Comorbidities impacting level of risk when combined with the medication

· Dosage risk for the patient

· Change in administration for existing medication

o Dosage change

o Dosage frequency

· Provider’s evaluation and decision related to the medication

· Level of risk based on decisions made during encounter

o May apply common language such as high, moderate, low, or straightforward supported by documentation

In the Examples section it clearly states that “medication list reviewed during encounter without evaluation” does NOT support medication management documentation. The other example they give that does NOT support documentation requirements is something often seen in provider documentation. It lists “continue medication without changes, without documentation supporting patient specific risks of continuing medication”.

We have waited patiently and not have more specific information to guide our providers when understanding that prescription drug management documentation is not satisfied by “refill meds” or “continue meds” in their notes. Please be sure to get this information to your auditors and providers to help guide them in achieving compliant documentation for their notes when trying to achieve moderate medical decision making and level 4 office visits and level 2 hospital visits among other E&M visits.