How to bill 96372 to Medicare?
Asked by: Prof. Brooklyn Mayer | Last update: April 14, 2025Score: 4.9/5 (72 votes)
Does CPT code 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.
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.
What is the 22 modifier for Medicare?
Modifier 22: Increased Procedural Services. This modifier is used to identify a service that requires significantly greater effort, such as increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required, than is usually needed for that procedure.
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.
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What is CPT code 96372 for Medicare?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
Can 96372 be billed with j3420?
The CCI edit shows that the codes can never be billed together and no modifier is allowed. You are required to bill the code that describes the service provided, which in this case would be the 96372.
What modifier is not accepted by Medicare?
GZ - Service is not covered by Medicare
The GZ modifier identifies that 1) an item or service is expected to be denied as not reasonable and necessary, and 2) no advance notice of non-coverage was supplied to the member.
What is the 33 modifier for Medicare?
Modifier 33 should be used when the primary purpose of the service is the delivery of an evidence-based service in accordance with the guidelines provided by one of the ACA-designated organizations, including an A or B recommendation from the USPSTF.
What is the modifier 27 for Medicare?
Hospitals may append modifier –27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is “separate and distinct E/M encounter” from the service previously provided that same day in the same or different hospital outpatient setting.
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.
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?
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.
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.
What is the 51 modifier for injections?
Modifier 51
When multiple procedures, other than Evaluation and Management (E/M), Physical Medicine and Rehabilitation services or provisions of supplies (e.g., vaccines) are performed at the same session by the same individual, the primary procedure or service may be reported as listed.
What is the JA and JB 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 82 modifier for Medicare?
Modifier 82
This modifier is used when minimal surgical assistance is needed, but a qualified resident was not available (documentation required). First, check Medicare Physician Fee Schedule (MPFS) Indicator/Descriptor List. Column A indicates if assistant at surgery allowed/not allowed.
Can you bill 99214 and G0439 together?
Medicare does discourage this and says there is too much 'crossover' between these two preventive services. We usually see a 99213 or 99214 with a G0438 or G0439 to represent the problem management outside the AWV. If you bill G0438/G0439 and a 99397, recognize that Medicare does not cover the 99397.
What is the 53 modifier for Medicare?
Any other codes billed with modifier -53 are subject to medical review and priced by individual consideration. Modifier-53 = Discontinued Procedure - Under certain circumstances, the physician may elect to terminate a surgical or diagnostic procedure.
What is procedure code 96372 used for?
The American Medical Association's Current Procedural Terminology (CPT) code 96372 is a medical procedural code for “therapeutic, prophylactic, and diagnostic injections (excluding chemotherapy and other highly complex drug or biologic agent administration); subcutaneous or intramuscular.”
Can you use modifier 33 with Medicare?
Claims submitted to Medicare containing modifier 33 will be returned with Medicare Outpatient Adjudication (MOA) code MA130, which indicates that the claim contains incomplete and/or invalid information that is “unprocessable.” As such, you should only append modifier 33 for non-Medicare payers, as per AMA instructions ...
What are three services not covered by Medicare?
We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.
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.
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).
Can 96372 be billed with J0696?
Rocephin (J0696) or Bicillin (J0561 x 24 units) or any other prescribed injectable medication provided by a RN for a STD treatment only visit may be billed as follows: 1) Bill the medication and the therapeutic injection fee (CPT code 96372).