Does CPT code 96372 require a modifier?
Asked by: Barney Volkman | Last update: December 7, 2025Score: 4.2/5 (3 votes)
What is the modifier 76 for CPT code 96372?
Commonly Used Modifiers for the 96372 CPT Code
This modifier indicates that the E/M service is separately identifiable and significant. Modifier 76: Used to inform payers that the same procedure is being repeated by the same provider.
What CPT codes require a 59 modifier?
Therapists often use modifier 59 to bill for “two timed code procedures [that] are performed sequentially in the same encounter.” For instance, if you billed CPT codes 97140 (Manual Therapy) and 97530 (Therapeutic Activities)—and you provided those services during separate and distinct 15-minute intervals—then, as ...
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.
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.
What is a Modifier in Medical Coding? CPT and HCPCS Modifiers for Beginners
What modifier is needed for CPT 96372?
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.
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.
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 modifier 25 in CPT coding?
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 you bill 99214 and 96372 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.
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.
When should a modifier be used?
Medical coders use modifiers to tell the story of a particular encounter. For instance, a coder may use a modifier to indicate a service did not occur exactly as described by a CPT® or HCPCS Level II code descriptor, but the circumstance did not change the code that applies.
What is included in CPT code 96372?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
What is a 58 modifier used for?
Modifier 58 is defined as a staged or related procedure performed during the postoperative period of the first procedure by the same physician. A new postoperative period begins when the staged procedure is billed.
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 the modifier 26 for CPT codes?
Modifier 26 represents the professional component of the procedure. The professional component of the global fee is for the reading and interpretation of the diagnostic procedure/service.
What is modifier 57?
Modifier 57 is used to indicate an Evaluation and Management (E/M) service resulted in the initial decision to perform surgery either the day before a major surgery (90 day global) or the day of a major surgery.
When to use modifier 95?
-95: Synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
What is the JW and JZ modifier used for?
The JZ modifier is reported to attest that no amount of drug was discarded. The JW modifier is required to be reported on a claim for the amount of drug that is discarded and eligible for payment.
When to use modifier kx?
Use of the KX modifier indicates that the supplier has ensured coverage criteria for the DMEPOS billed is met and that documentation does exist to support the medical necessity of item.
What is the EJ modifier used for?
Billing subsequent injections in a series (EJ modifier)
The EJ modifier must be used with the HCPCS code for the drug administered to indicate subsequent injections of a series. The modifier is not to be used with the first injection of each series.
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.
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 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.