Sub-Q infusions lasting 15 minutes or less are reported with the sub-Q/IM injection code for drug administration, 96372. All procedures are valued for reimbursement to include an assessment of the patient at the encounter (vital signs, appearance of the patient, etc.).
Full Answer
What code do you Bill 96372 with?
I really respect your advise on our posts. We bill 96372 with J1055 (now J1050) with V25.49. My Medicaid biller is the one that states that she was advised this is a non allowable code.
What does E/M of 96372 mean?
The nurse is only following physician orders; if anything is out of the ordinary, the physician is called in, the injection is abandoned, and a higher level E/M is reported. For example, in an obstetric /gynecology office setting, a Depo-Provera® (Depo) injection would be a scheduled visit reported with 96372 only.
Can I report 99211 and 96372 at the same time?
Bottom Line: Insurance payers are not paying 99211 when reported on the same date of service as 96372. If you report these codes in combination, the payer will deny the claim.
Is j1050 a non allowable code for 96372?
We bill 96372 with J1055 (now J1050) with V25.49. My Medicaid biller is the one that states that she was advised this is a non allowable code. I instructed the office in the change to the injection code and the Medicaid biller is the one that said her conference with Medicaid several months ago advised it was not allowable.
Does Medicare pay for CPT code 96372?
CPT code 96372 is used for certain types of vaccinations. Most vaccinations are typically coded with 90471 or 90472. Medicare uses G0008 as the administration code for flu vaccinations. Procedure code 96372 is billed for injections related to the provision of chemotherapy services.
Is 96372 Included in office visit?
If you administer an injection in your office, e.g., naltrexone extended-release (Vivitrol®) or depot antipsychotics, you can bill for the administration of the injection separately from the billing for the visit itself. The CPT code 96372 should be used–Therapeutic, prophylactic, or diagnostic injection.
Can 96372 be billed with 99214?
Yes, it does as long as the documentation supports the E/M and admin.
What is included in CPT 96372?
The Current Procedural Terminology (CPT®) code 96372 as maintained by American Medical Association, is a medical procedural code under the range - Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration).
Does 96372 require a modifier?
The 96372 CPT code is to be billed for each injection performed on a patient. Modifier 59 should be used when the injection is a separate service from other treatments.
Can you bill 96372 with 2 units?
The IM or SQ injection can be billed more than once or twice. If the drug is prepared and drawn up into two separate syringes and it is then administered in two individual injections in two distinct anatomic sites, you can bill two units of code 96372 (billing second unit with modifier 76).
What CPT code replaced 96372?
CPT 9921196372 CPT Code Description CPT 99211 will be reported instead of 96372CPT when a substance is injected without a physician's supervision. It excludes administration of Vaccines or toxoids and is separately billable.
Can 96372 be billed with 99213?
Yes. Put modifier-25 on your office visit and your 96372 will get paid as long as the patients insurance benefits cover it.
Can a nurse Bill 96372?
Question: If a patient pays for her medicine and goes to the clinic for the nurse to give the injection, we can bill CPT 96372 (Therapeutic, prophylactic or diagnostic injection ...).
Does Medicare pay for venipuncture?
Physician-Performed Venipuncture If a venipuncture performed in the office setting requires the skill of a physician for diagnostic or therapeutic purposes, the performing physician can bill Medicare both for the collection – using CPT code 36410 – and for the lab work performed in-office.
Can an office visit be billed with an injection?
It is true that an evaluation and management code, an E/M or office visit, can be reported with a minor procedure such as an injection, but only if the E/M is significant and separate and exceeds the “pre-service evaluation” that is inherent to the injection.
How do I bill for 2 injections?
Answer: CPT code 96372… should be reported for each intramuscular (IM) injection performed. Therefore, if two or three injections are performed, it would be appropriate to separately report code 96372 for each injection.
Why is CPT 96372 not being paid?
Providers are not being paid for this injection administration code because it is being applied incorrectly, insurance companies say. Here’s why.
What is the purpose of 96372?
The primary intent of an injection as described by 96372 is generally to deliver a small volume of medication in a single shot. The substance is given directly by subcutaneous (sub-Q), intramuscular (IM), or intra-arterial (IA) routes, as opposed to an intravenous (IV) injection/push that requires a commitment of time.
What is a procedure valued for reimbursement?
All procedures are valued for reimbursement to include an assessment of the patient at the encounter (vital signs, appearance of the patient, etc.). If a procedure is scheduled in advance of the encounter, the medical necessity for that procedure has already been determined and the treatment has already been decided.
Can you report 96372 in the hospital?
You may report 96372 in the facility without the physician present. Injections for allergen immunotherapy have their own administration codes, 95115-95117. Do not report 96365-96379 with any codes that describe a procedure of which IV push or infusion are a part.
Can you bill an E/M with an injection?
This is not possible with a scheduled injection performed by a nurse.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy.
Article Guidance
The Medicare Administrative Contractor has determined in review of submitted claims that there is inappropriate use of CPT codes 96401-96549 for chemotherapy and other highly complex drug or highly complex biologic agent administration.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.