re: 96372 for Medicare They are possibly denying it since no corresponding drug code is on the claim. Check with Provider Services @ your Medicare MAC.
Is there a problem with CPT code 96372?
May 14, 2020 · I keep getting a denial for CPT code 96372. Code M67: Missing/incomplete other procedure code(s). The patient comes into the office for Abilify injection. He brings his own medicine with him so I cannot bill for the medication. I only code for the injection. Not sure what I am doing wrong. Any advice on this would be grately appreciated. Thank you
Is the admin fee (96372) denied by Medicare and Blue Cross?
Jun 07, 2021 · 96372 Denying Incorrectly Requiring JA or JB Modifier - Resolved 07/23/21. Provider/Supplier Type (s) Impacted: All provider types. Claim Coding Impact: 96372. Description of Issue: An issue was identified for claims billed with code 96372 for dates of service on/after 04/01/21. Claims processed between 05/19/21 and 06/07/21 may have received incorrect …
Is j1050 a non allowable code for 96372?
CPT code 96372 is not correctly recorded, showing that a treatment or service was different or unique from other operations done on the same day. CPT code 96372 is assigned to specific types of vaccines. The majority of vaccines are generally classified as 90471 or 90472. G0008 is the Medicare administrative code for flu vaccines.
Is there a way to unbundle a 96372 procedure?
CPT codes 96372-96379 are not intended to be reported by the physician in the facility setting. Thus, when an E/M service and a therapeutic and diagnostic Injection service are submitted with CMS Place of Service (POS) codes 19, 21, 22, 23, 24, 26, 51, 52, and 61 for the same patient by the Same Individual Physician or Other Qualified Health Care Professional on the same date of …
Can 96372 be billed to Medicare?
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.
Can CPT 96372 be billed alone?
Can CPT Code 96372 Be Billed Alone? Yes, it is allowed to be billed alone when the injection is performed alone or in conjunction with other procedures/services as allowed by the National Correct Coding Initiative (NCCI) procedure to procedure editing.
Does CPT 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.
Is CPT 96372 An administration code?
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).
How do you bill for injection only?
The CPT code 96372 should be used–Therapeutic, prophylactic, or diagnostic injection.
What is included in CPT 96372?
CPT® code 96372: Injection of drug/substance under skin or into muscle.
How do you bill for IV infusion?
Intravenous (IV) infusions are billed based upon the CPT®/HCPCS description of the service rendered. A provider may bill for the total time of the infusion using the appropriate add-on codes (i.e. the CPT®/HCPCS for each additional unit of time) if the times are documented.
Why is CPT code 96372 denied?
CPT code 96372 is reported by the physician in a facility setting. CPT code 96372 is submitted together with an E/M service ...
What is CPT code 96372?
CPT code 96372 is not properly documented indicating that a procedure or service was distinct or independent from other services performed on the same day . CPT code 96372 is used for certain types of vaccinations. Most vaccinations are typically coded with 90471 or 90472.
When to use modifier 59?
Modifier 59 is used when it is not medically necessary. Modifier 59 is used to indicate that a procedure code was performed more than once per day. Instead, use anatomical modifiers to distinguish their repeat procedures. If those were not available, use modifier 76 (repeat service), as MAC directed.
What does modifier 59 mean in CPT?
In other words, appending CPT modifier 59 indicates that the injection is a separate service. Note that for professional reporting, code 96732 requires direct physician supervision. It is reported per injection, even if more than one substance or drug is in the single injection.
What is CPT 96372?
Across the country, in offices and facilities, coders are having trouble with CPT® 96372 Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular. As this code is applied incorrectly, providers are not being paid for this injection administration code.
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 the code for preventive medicine?
The Preventive Medicine codes (99381-99412, 99429) do not need Modifier 25 to indicate a significant, separately identifiable service when reported in addition to the diagnostic and therapeutic Injection service. The Preventive Medicine codes include routine services such as the ordering of immunizations or diagnostic procedures.
Can you use E/M and injections at the same time?
When an E/M service and an Injection or Infusion service are submitted for the same enrollee on the same date of service, there is a presumption that the E/M service is part of the procedure unless the physician identifies the E/M service as a separately identifiable service. You will separately reimburse the same physician for both an Injection ...
Does the E/M code need a modifier?
Since the Injection procedure does not include the components of a Preventive Medicine E/M service, the Injection can be reported separately and the Preventive Medicine E/M code does not need a modifier to indicate it is distinct or separate from the Injection procedure.
Is CPT code 96372-96379 paid?
As this code is applied incorrectly, providers are not being paid for this injection administration code. CPT codes 96372-96379 are not intended to be reported by the physician in the facility setting.
What to do if SNF refuses to pay Medicare?
If the SNF refuses to pay, providers may call the Part A Contact Center to inform the SNF about the situation. The SNF needs to bill Medicare for virtually all the SNF resident's services received during a covered Part A stay. Under the consolidated billing requirement, the SNF itself should bill.
Can RNFAs be part of Medicare?
No. RNFAs are not recognized Medicare providers. The RNFA can perform the service; however, even under "incident to" rules, they are not able to have their time allowed separately. If the RNFA is employed by the hospital, Part A payment would include that ancillary staff.
Can you use a QQ modifier in 2020?
No. Using a QQ modifier in 2020 will not determine the payment or denial of the claim. In 2021, it will affect payment. It would not be appropriate to use a M modifier and a QQ modifier together as some of the M modifiers contradict a QQ modifier. Use of certain M modifiers require a G code to be added on the claim.
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
Title XVIII of the Social Security Act, §1861 (t) states that these drugs may be paid when they are administered incident to a physician’s service and determined to be medically reasonable and necessary
Article Guidance
This Medicare Administrative Contractor (MAC) 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.