CPT code 96372 is used for billing when a healthcare provider administers a therapeutic, preventive, or diagnostic injection directly into a muscle (IM) or beneath the skin (subcutaneous route). This service is typically provided in a clinical setting, such as a physician’s office, hospital outpatient department, or urgent care facility.
This code is commonly used when a patient receives an injection such as:
According to the American Medical Association (AMA), the full description for CPT code 96372 is:
It is important to note that the substance or drug injected is not included in this code and must be billed separately using the appropriate NDC code (National Drug Code).
When billing CPT 96372 with other services, appropriate modifiers may be required to avoid denials:
Example:
If a patient receives an injection during a routine check-up, bill 96372 with modifier 25 on the E/M code to show that both services were necessary.
Reimbursement for CPT 96372 depends on the payer, region, and whether the service is part of a bundled payment model. On average:
Always verify with the 96372 CPT code fee schedule specific to your location or payer.
Under Medicare guidelines, CPT 96372 is reimbursable when:
Medicare does not cover 96372 if the injection could be self-administered by the patient at home, unless documented.
Use modifier 59 with 96372 when the injection is provided separately from another procedure (e.g., during a wound treatment session). This modifier prevents claim bundling and increases the chance of reimbursement approval.
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As of 2024, here are the estimated values:
To get exact rates, refer to your local Medicare Administrative Contractor (MAC) or check the CMS Physician Fee Schedule database.
Drugs administered under CPT 96372 must be reported separately using their NDC code. Always:
When submitting the claim, make sure to specify the type of medication or substance injected, along with the correct administration route.
Per CMS (Centers for Medicare & Medicaid Services) regulations, claims should include both the HCPCS drug code and CPT 96372 to ensure proper reimbursement.
Frequency depends on the medical necessity and payer policy. For example:
Avoid medical billing multiple units unless the same code is medically justified and documented for separate injections.
CPT code 96372 plays a key role in medical billing for injections. By understanding its use, modifiers, Medicare rules, and documentation requirements, providers can ensure timely reimbursements and compliance with payer policies.
Whether you’re billing for a routine antibiotic shot or a therapeutic injection during a scheduled visit, accurate coding and documentation make all the difference.
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