How many times can you bill a CPT 96374?

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You can bill CPT code 96374 only once per patient encounter (per vascular access site).

Core Billing Rules

  • Initial Service Only: CPT 96374 represents the initial or single intravenous (IV) push of a therapeutic, prophylactic, or diagnostic substance.
  • Unit Limit: Report exactly 1 unit of 96374 per encounter when it qualifies as the primary administration.
  • Subsequent Pushes: If the patient receives additional IV pushes of different drugs during the same session, bill the add-on code 96375 for each subsequent new substance.
  • Hierarchy Limits: If an IV infusion (such as CPT 96365) or a higher-ranking service is performed during the same encounter, the infusion takes priority as the initial service, meaning 96374 cannot be billed at all.

Does CPT 96374 require a modifier?

No, CPT code 96374 does not require a modifier by default.

You only need to append a modifier to CPT Code 96374 under specific clinical circumstances or bundling conflicts.

When Modifiers Are Used with 96374

  • Modifier 59 (Distinct Procedural Service): Add this when 96374 is performed during a separate, distinct patient encounter on the same calendar day (such as a patient leaving the clinic and returning later for an independent push).
  • X-subset Modifiers (XE, XP, XS, XU): Depending on your payer and specific NCCI edits, you may use an X modifier instead of modifier 59 to denote a separate structure (XS) or distinct anatomical site.
  • Modifier 25: Note that modifier 25 is never appended to 96374 itself. Instead, it is attached to a same-day Evaluation and Management (E/M) code to show that the E/M service was significant and separate from the injection administration.

What revenue code should be billed with 96374?

When billing for CPT code 96374 (initial IV push) on an institutional or hospital outpatient UB-04 claim form, you should use Revenue Code 0260 (IV Therapy - General Classification) or 0262 (IV Therapy - Pharmacy Services), depending on your facility’s specific internal chargemaster guidelines.

📊 Common Facility Revenue Codes

  • 0260: IV Therapy - General Classification (most widely used default)
  • 0262: IV Therapy - Pharmacy Services
  • 0450 / 0456: Emergency Room (if administered in the ED/ER urgent area instead of outpatient clinic)
  • 0510 / 0516: Clinic - General or Urgent Care (if administered in a hospital-based clinic setting)

💡 Key Billing Considerations

  • Location-Driven: Match the revenue code to the specific cost center or nursing station where the IV push actually occurred.
  • Professional vs. Facility: Revenue codes apply strictly to institutional (facility) billing; professional claims use Place of Service (POS) codes on a CMS-1500 form instead.
  • Paired Coding: Ensure you also report the specific drug using the appropriate HCPCS/J-code alongside a pharmacy revenue code (such as 0250) if required by your payer.

What is billing code 96374?

Billing code 96374 is a CPT Code used to report the initial or primary intravenous (IV) push administration of a single therapeutic, prophylactic, or diagnostic non-chemotherapy drug.

What is an IV Push?

  • An IV push means a nurse or doctor injects medication directly into a vein quickly.
  • This injection usually takes 15 minutes or less.
  • The provider must stay with the patient during the injection.

When to Use Code 96374

  • Use it for the very first or primary drug given by an IV push during a patient visit.
  • Common examples include giving a quick dose of medicine for severe nausea, pain, or an allergic reaction in an office or urgent care.
  • It only covers the hands-on work of giving the drug, not the cost of the drug itself.

Important Billing Rules

  • Not time-based: Unlike standard IV drips, this code does not track long hours. It is assigned per encounter based on medical rules.
  • Hierarchy limits: You can generally only bill one "initial" drug administration code per vascular site during a visit. If the patient gets a longer infusion, that takes priority over the push.
  • Additional drugs: If a second, different drug is pushed later through the same line, bill it using add-on code 96375 instead.

You can read more details about requirements on the Cadence Collaborative Overview.

Can you bill CPT 96374 and 96375 together?

Yes, CPT code 96374 and add-on code 96375 can be billed together when a patient receives an initial intravenous push of one drug followed sequentially by an IV push of a different, distinct drug during the same encounter.

Core Billing Rules

  • Primary and Add-On: CPT 96374 serves as the primary code for the initial or single IV push. CPT 96375 is an add-on code that must be reported in conjunction with a primary service like 96374.
  • New Substance: The second administration billed under 96375 must be a new, distinct medication given sequentially through the same IV access.
  • Repeat Dosing: Do not use 96375 if the provider administers a repeat dose of the same medication; use CPT 96376 instead.
  • Hierarchy Checks: Ensure that no higher-level service on the same vascular access site (such as a primary therapeutic infusion like 96365) supersedes 96374 as the initial code for the encounter.

Understanding CPT codes

9 related questions found

What does the modifier 59 represent in CPT code 96374?

CPT code 96374 with modifier 59 indicates a distinct, separate intravenous (IV) push administration of a single or initial drug during a completely separate encounter or session on the same calendar day.

What CPT 96374 Means

  • Service: Initial IV push of a therapeutic, prophylactic, or diagnostic substance.
  • Delivery: Rapid injection directly into a vein.
  • Limit: Normally billed only once per encounter.

When to Use Modifier 59

  • Separate Encounters: The patient leaves the facility or clinic and returns later the same day for a new, medically necessary IV push.
  • Bypassing Edits: It signals to insurance payers that the second 96374 code is not a duplicate or unbundled error, but a distinct procedural service.
  • X-Subset Alternative: Many payers prefer more specific X{EPSU} modifiers (such as XE, XS, XP, or XU) over modifier 59 when applicable. For example, modifier XS represents a separate anatomical structure or separate IV site.

Common Billing Mistakes

  • Same-Session Pushes: Do not use modifier 59 for multiple pushes given during the continuous, same patient encounter through the same IV line. Use code 96375 for additional sequential pushes of new substances instead.
  • Missing Documentation: Charts must clearly show separate start and stop circumstances or distinct clinical encounters to support the modifier.

What is the difference between the CPT codes 96374 and 96375?

CPT code 96374 is the primary, standalone code for the initial intravenous (IV) push of a single therapeutic, prophylactic, or diagnostic drug, while CPT code 96375 is an add-on code used for each additional sequential IV push of a new and different substance during the same patient encounter.

Key Differences at a Glance

  • Code Type:
    • 96374: Primary (can stand alone on a claim).
    • 96375: Add-on code (cannot be billed by itself; must accompany a primary code like 96374).
  • Usage in an Encounter:
    • 96374: Used for the very first IV push drug given, or to open the administration episode when an injection takes 15 minutes or less. Only one initial service code is typically allowed per encounter.
    • 96375: Used sequentially for the second, third, or subsequent drug, provided each substance is a new and different drug administered through the same IV site. It cannot be used for repeat doses of the same medication.
  • Reimbursement Rates (2026 Medicare Estimates):
    • 96374: Pays roughly $37 to $50 depending on specific rules and settings.
    • 96375: Pays a lower incremental rate, roughly $15.70 per additional unit.

Example Scenario

If a patient comes in and receives an IV push of ondansetron for nausea, you bill 96374 as the initial push. If the clinician then administers a second, entirely different medication like ketorolac for pain through the same IV line sequentially, you append 96375 on the same claim for that second medication.

Can you provide a cheat sheet for coding infusion and injection services?

Review the Centers for Medicare & Medicaid Services Billing and Coding Guidelines for precise rules on injection, infusion, and hydration services.

Core CPT Code Categories

  • Hydration:
    • 96360 (Initial, 31–60 minutes)
    • 96361 (Each additional hour)
  • Therapeutic / Prophylactic / Diagnostic (TPD):
    • 96365 (Initial infusion, ≥16 min up to 1 hr)
    • 96366 (Each additional hour)
    • 96367 (Sequential new drug infusion, ≥16 min)
    • 96368 (Concurrent infusion)
    • 96374 (Initial IV push)
    • 96375 (Additional sequential IV push, new substance)
    • 96376 (Same substance push, repeat >30 min apart)
    • 96372 (Therapeutic/diagnostic subcutaneous/intramuscular injection)
  • Chemotherapy / Complex Biologics:
    • 96413 (Initial IV infusion, up to 1 hr)
    • 96415 (Each additional hour)

Key Rules & Time Guidelines

  • Initial Service Limit: Report a maximum of one initial service code per vascular access site per encounter.
  • Infusion vs. IV Push: Infusions require 16+ minutes. Any infusion lasting 15 minutes or less is coded as an IV push.
  • Hydration Minimum: Must run for at least 31 continuous minutes to be reportable; ≤30 minutes is bundled/unreportable.
  • Documentation Essentials: Mandatory start and stop times, substance name, dosage, and total volume.

Facility Hierarchy Rules

When multiple services are given in a facility setting, order and choose initial codes via this descending hierarchy:

  1. Chemotherapy administration (infusion > push > injection)
  2. Therapeutic / Prophylactic / Diagnostic (infusion > push > injection)
  3. Hydration therapy

Can you provide an example of a revenue code?

An example of a revenue code is 0450, which represents general emergency room services in medical billing.

What is a Revenue Code?

  • A four-digit number used on institutional billing forms like the UB-04.
  • Identifies the specific department or cost center where a patient received care.
  • Maintained by the National Uniform Billing Committee (NUBC).

Common Examples

  • 0250: General pharmacy services
  • 0300: General laboratory services
  • 0360: Operating room services
  • 0420: General physical therapy

What are the guidelines for reporting concurrent infusions?

Reporting concurrent infusions requires a secondary drug or substance to infuse simultaneously with a primary infusion through the same intravenous (IV) access site.

Core Rules for CPT 96368 (Concurrent Infusion)

  • Simultaneous Timing: Both the primary and concurrent drugs must be actively infusing at the same time, with a clear documented overlap in administration times.
  • Same IV Access: Both substances must run through the same IV line, catheter, or port location. If a patient has two separate IV sites, concurrent codes do not apply.
  • Frequency Limit: Code 96368 is reported only once per encounter, no matter how many concurrent drugs are running at the same time.
  • Not Time-Based: Unlike initial or sequential infusion codes, 96368 has no minimum duration requirement; as long as the overlap occurs, it is reportable once.
  • Exclusions: Hydration administration cannot be reported as a concurrent infusion. Multiple substances mixed into a single bag are counted as a single infusate, not a concurrent infusion.

Documentation Requirements

  • Timestamps: Must record exact start and stop times for both the primary and concurrent infusions to prove the overlap window.
  • Site Confirmation: Nursing notes or the Medication Administration Record (MAR) must verify that both substances used the exact same line or access site.