Can 96372 be billed twice?
Asked by: Edgar Wyman IV | Last update: June 22, 2025Score: 4.2/5 (66 votes)
Can you bill a CPT code 96372 twice?
Report Per Injection – code must be reported per injection, not per substance. This means that if there is more than one substance in the injection, it is only billed once.
Do you need modifier 25 with 96372?
required for the Injection service, Modifier 25 may be reported for the EM service in addition to 96372-96379. E/M service code 99211 will not be reimbursed when submitted with a diagnostic or therapeutic Injection code, with or without Modifier 25.
Can 96372 be billed with an office visit?
Yes, CPT code 99214 (office visit, established patient) can be billed alongside 96372, but the documentation must clearly show that the injection was separate from the evaluation and management (E/M) service.
How do I bill Medicare for multiple injections?
If a provider wishes to report multiple injections (intramuscular or subcutaneous) of the same therapeutic medication, he or she may choose to report code 96372 (therapeutic, prophylactic, or diagnostic injection [specify substance or drug]). The number of administrations would be reported as the units of service.
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What are the guidelines for billing 96372?
When a patient receives two or three intramuscular or subcutaneous injections, CPT code 96372 should be reported for each injection performed (either IM or SubQ). Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form.
What modifier do you use for multiple injections?
It is reported per injection, even if more than one substance or drug is in the single injection. Note that when reporting multiple injections for professional services, you should append modifier 59 Distinct procedural service to the second and subsequent units of 96372.
How do I bill 96372 to Medicare?
CPT code 96372 should be adequately documented to indicate that it is a particular or independent service from other services provided on the same day. Using procedure code 96372 for vaccinations is inappropriate; instead, codes like 90471, 90472, or G0008 (for Medicare) should be used.
Why is Medicare denying 96372?
Providers are not being paid for this injection administration code because it is being applied incorrectly, insurance companies say. Here's why. The primary intent of an injection as described by 96372 is generally to deliver a small volume of medication in a single shot.
Can you bill 96372 and J3301 together?
Yes, CPT code 96372, which is for therapeutic, prophylactic, or diagnostic injection, can be billed alongside J3301 if an injection of triamcinolone acetonide (Kenalog) is administered. J3301 covers the medication, while 96372 covers the injection procedure itself, so both can be billed together if applicable.
Can modifier 25 be used twice?
Yes, you can add modifier 25 to CPT code 99214 if a significant, separately identifiable E/M service is performed on the same day as another procedure.
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.
Can you bill 99211 and 96372 together?
Answer: You cannot ever bill 99211 with 96372. In fact, according to the Correct Coding Initiative (CCI), no modifier will separate the edit bundling these codes together, so there are no circumstances under which they can be reported together.
How do I bill 20610 twice?
For example, if the provider performs an aspiration and injection on the left knee and a separate aspiration and injection on the right knee, two units of the 20610 code can be reported, each with the designated modifiers for bilateral procedures.
Can you bill 20610 and 96372 together?
This means you should not unbundle the code pair. However, code 20610 is also bundled with code 96372 (Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular), but for this pair the modifier indicator is 1.
What is CPT code 96372 denial?
Common Denial Reasons for CPT Code 96372
Administering CPT code 96372 in a non-facility setting without adequate supervision. Including comprehensive client evaluation already covered in the procedure. Billing for injection when the necessity was established during a prior visit (billed as an E/M code).
What is the CPT code for B12 injection administration?
Coding a B12 injection
Is 90782, “Therapeutic, prophylactic or diagnostic injection (specify material injected); subcutaneous or intramuscular,” the proper code for administering a vitamin B12 injection in the office if the patient provides the medication?
Is 96372 an admin code?
Instead, the administration of the following drugs in their subcutaneous or intramuscular forms should be billed using CPT® code 96372, (therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular).
When can a right, left, or bilateral modifier be reported with a CPT code?
Reporting these bilateral-indicator-1 procedures with either LT or RT and 1 unit of service is appropriate only if the procedure is being performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service.
How to bill 2 units of 96372?
How should the units and administration of the 96372 CPT code be recorded? Each administration of the injection should be documented separately using the 96372 CPT code. If a patient receives multiple injections in a single visit, each injection should be accounted for.
Can 96372 and 95117 be billed together?
Per NCCI, 96372 does bundle to 95117, but a modifier is allowed. For 96401, there is no NCCI bundling relationship, so no modifier should be required.
What is the difference between CPT code 96372 and 90471?
90471 should be used for vaccines and 96372 for drugs. You need to make sure when billing 96372 that you use a 59 modifier on the drug or it won't pay.
What is the 51 modifier for injections?
Modifier 51
When multiple procedures, other than Evaluation and Management (E/M), Physical Medicine and Rehabilitation services or provisions of supplies (e.g., vaccines) are performed at the same session by the same individual, the primary procedure or service may be reported as listed.
What is the modifier 25 rule?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
What is the 57 modifier used for?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.