Can you bill 96372 alone?
Asked by: Arnaldo Watsica | Last update: June 16, 2025Score: 4.4/5 (71 votes)
Can a CPT code 96372 be billed alone?
96372 CPT code reimbursement is allowed when the injection is performed alone or with other procedures/services as permitted by the National Correct Coding Initiative (NCCI) procedure to procedure editing.
What is the CPT code 96372 billing guidelines?
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. Requirements for Reimbursement: Direct Physician Supervision – must be done under the direct supervision of an MD.
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.
Why is Medicare denying 96372?
Using procedure code 96372 to bill for a provided service during a previous visit or billed as an E/M code during the same visit will result in denial. To bill an additional E/M service provided with the injection during the same visit, the healthcare provider must ensure appropriate documentation is in place.
J3301 and Medicare Medical Coding
Can cpt code 99214 and 96372 be billed together?
Can CPT code 99214 and 96372 be billed together? 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.
Are injectable drugs covered by Medicare Part B?
Injectable and infused drugs: Medicare covers most injectable and infused drugs when a licensed medical provider gives them. Oral End-Stage Renal Disease (ESRD) drugs: Medicare covers some oral ESRD drugs if the same drug comes in an injectable form and the Part B ESRD benefit covers it.
Can you bill 96372 with 99211?
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.
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.
Do you bill 96372 with J3301?
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 you bill 96372 and 95117 together?
Allergy injection codes and E/M codes should not be filed on the same day unless the E/M is separately identifiable. If the E/M is separately identifiable, append modifier -25 to the office visit. Code 96372 does not include injections for allergen immunotherapy. For allergen immunotherapy injections, use 95115-95117.
Which drugs require a jz modifier?
Effective July 1, 2023, providers and suppliers are required to report the JZ modifier on all claims that bill for drugs from single-dose containers that are separately payable under Medicare Part B when there are no discarded amounts.
What is a therapeutic prophylactic injection used for?
A therapeutic, prophylactic, or diagnostic IV infusion or injection (other than hydration) is for the administration of substances or drugs.
How many units can you bill for 96372?
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.
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?
What is procedure code 96372?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
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.
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.
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.
Does 96372 need modifier 59?
For example, if you administer two separate drugs, but use three injections to administer them, you would report two injections (96372, 96372-59 Distinct procedural service, and the drug supply codes).
Do you bill 96372 with J0171?
Answer: Use of an EpiPen® represents an injection of epinephrine. As such, it would be appropriate to code its administration using codes 96372 (Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular) and J0171 (Injection, adrenalin, epinephrine, 0.1 mg).
What is the CPT code for administration of injections?
Subcutaneous and Intramuscular Injection Non-Chemotherapy
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).
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Is prednisone a part B or D?
Certain drugs such as Prednisone are covered under Part B when they are used to prevent organ rejection for a patient who has had a Medicare covered transplant.
How can seniors afford Eliquis?
Patients who have prescription insurance through Medicare pay, on average, $55 per month. And 5 out of 10 ELIQUIS patients pay $40 or less. Low-Income Subsidy patients may pay $0 to $11.20 per month through the Social Security Administration's Extra Help4 program. Use this link to learn about Extra Help.