Can you bill 20610 and 96372 together?
Asked by: Mrs. Misty Vandervort MD | Last update: April 3, 2025Score: 4.4/5 (62 votes)
How do I bill 96372 for 2 injections?
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. It is important to accurately record the number of units for each administration.
Can you bill for two CPT codes at the same time?
There is a myth that exists that you can't bill 2 CPT codes during the same 15-minute time period. Well, that myth is only partially true. It is possible to bill 2 CPT codes during the same 15-minute time period.
What are the billing guidelines for 20610?
The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. The charge, if any, for the drug or biological must be included in the physician's bill and the cost of the drug or biological must represent an expense to the physician.
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.
CPT 20610 Billing Scenarios
Can cpt 99213 and 96372 be billed together?
Separate reimbursement will not be allowed for CPT code 96372 when billed with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same service date.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
Can 96372 be billed with 20610?
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.
Can I bill 20610 twice?
Multiple Units and Bilateral Procedures for 20610 CPT Code
Generally, only one unit of the 20610 code should be reported for each joint treated, regardless of the number of aspirations and injections performed.
Can you bill an office visit with a joint injection?
Answer: Unfortunately, no. 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.
When to use 59 or 51 modifier?
Modifier -51 would be attached because the biopsy is the lesser-valued procedure done at the same session, and modifier -59 would be attached to indicate that the biopsy, which is normally bundled with excision of the same lesion, was done on a separate lesion from the one that was excised.
How do you write a CPT code with two modifiers?
In the case of more than one modifier, you code the “functional” modifier first, and the “informational” modifier second. The distinction between the two is simple: you always want to list the modifiers that most directly affect the reimbursement process first.
How do you bill two E&M on the same day?
If you see a patient in separate settings on the same date of service, you should not add the time together, even if you were accustomed to billing that way for years. Instead, you can report two separate E/M codes with modifier 25 appended.
Can you bill 96372 without an office visit?
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.
Is CPT code 20610 considered surgery?
CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. This code typically applies to treatments for conditions like arthritis or bursitis to relieve pain and inflammation.
How do you bill for bilateral injections?
Question: What is the appropriate way to bill a bilateral injection and drug? Answer: Medicare states that you bill bilateral procedures on one line with modifier -50. 67028 -50, 1 unit and double the amount. Submit with the bilateral diagnosis.
Can you bill 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.
Does 20610 need a modifier?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
What are the guidelines for billing 96372?
Using 96372 for billing a service provided in a previous visit or even billed as an E/M code for the same visit will also result in the denial. CPT 96372 must be accurately documented to indicate that it is an independent service from other services rendered to a patient on the same day.
Can you bill 96372 with 20552?
Can 96372 be billed with 20552, 20553, 20610 and 27096? Code 96372 is a component of Column 1 code 27096 but a modifier is allowed in order to differentiate between the services provided. No, 96372 is included in those injection procedures.
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).
Is modifier 25 needed for injections?
A modifier -25 may be required for the office visit when a vaccine is administered. Modifier -25 indicates that the E/M code for the office visit represents a distinct and significant service that is separate from the vaccine administration.
What is the CMS rule for modifier 25?
Use modifier 25 (same-day significant, separately identifiable E/M service) on the claim when you report critical care services unrelated to the service or procedure that you perform on the same day. You must also document the medical record with the relevant criteria for the respective E/M service you're reporting.
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.