Do you need modifier 25 with 96372?
Asked by: Dr. Dakota Maggio | Last update: July 7, 2025Score: 4.2/5 (68 votes)
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. Requirements for Reimbursement: Direct Physician Supervision – must be done under the direct supervision of an MD.
When should a 25 modifier be used?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can 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.
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.
EXAMPLES OF WHEN TO APPLY MODIFIER 25 TO EVALUATION AND MANAGEMENT LEVELS MEDICAL CODING
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.
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 you bill 99213 with modifier 25?
If the E/M is not bundled into the stress test, then the Cardiologist's coder can use modifier 25 to indicate that these two services were separate and significant: 99213-25, 93015.
Can we bill 99214 with 96372?
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.
What is the modifier for injection with office visit?
You do not need a different diagnosis to use the 25 modifier with the visit level. You only need the documentation to support a significant encounter from the injection administration. You would never bill the E&M code and the Jcode for the drug only.
Can you use modifier 25 with Medicare?
The Centers for Medicare & Medicaid Services (CMS) requires that modifier 25 be used only on claims for E/M services and only when the E/M service is provided by the same physician on the same day as another procedure or service.
Can you bill an E&M 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.
How do I know which modifier to use?
The correct modifier to use is determined by payor preference. There can be instances where a CPT code is further defined by an HCPCS modifier, for example, to describe the side of the body the procedure is performed on, such as left (modifier -LT) or right (modifier -RT).
How do you know if a CPT code needs a modifier?
- The service or procedure has both professional and technical components.
- More than one provider performed the service or procedure.
- More than one location was involved.
- A service or procedure was increased or reduced in comparison to what the code typically requires.
What is modifier 25 in CPT coding?
Modifier 25 is used to signify that when a separate identifiable evaluation-and-management (E/M) service was performed, which can refer to two evaluation-and-management (E/M) services, or a procedure plus an 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 you bill a 96372 with an office visit?
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.
Do I need a modifier for 99214?
Does 99214 need a modifier? Modifiers can be used with 99214 if applicable. For example, you can add Modifier 25 to the E/M visit with 99214 if there was a “separately identifiable E/M on the same day of a procedure” (source: ACC). Or add modifier 22 if the procedure was extra complex.
What is included in CPT code 96372?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
When to use 25 and 59 modifiers?
Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.”
What is the UHC modifier 25 policy?
For example, the description for modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service) specifies that it is to be reported with an Evaluation and Management (E/M) service.
Does modifier 25 or 95 go first?
Since both modifier 25 and 95 can impact payment, list modifier 25 first.
Can you bill 99214 with 96372?
Separate reimbursement will not be allowed for CPT code 96372 when billed in conjunction with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same date of service.
When to use ja modifier?
The use of the JA and JB modifiers is required for drugs which have 1 HCPCS Level II (J or Q) code but multiple routes of administration. Drugs that fall under this category must be billed with JA Modifier for the intravenous infusion of the drug or billed with JB Modifier for subcutaneous injection of the drug.
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?