What are the guidelines for billing 96372?
Asked by: Dean Goodwin I | Last update: August 28, 2025Score: 4.1/5 (65 votes)
How do you bill a procedure code 96372?
When a patient receives two or three intramuscular or subcutaneous injections, CPT code 96372 should be reported for each injection performed (either IM or SubQ). Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form.
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.
How many times can you bill 96372?
Therefore, if two or three injections are performed, it would be appropriate to separately report code 96372 for each injection. Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form.
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.
CPT Code 99490 Billing Guidelines
What are the new guidelines for modifier 25?
Do not use modifier 25 by a physician other than the physician performing the procedure or physician of the same specialty in the same group practice. Do not use modifier 25 when documentation does not support a significant, separately identifiable E/M service.
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.
Is 96372 an admin code?
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).
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 51 used for?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
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 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 modifier 59?
Definitions. Modifier 59 describes a distinct procedural service, and is used to identify procedures and services that are not normally reported together.
Can I bill 96372 with an office visit?
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.
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).
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.
What is the difference between modifier JW and JZ?
1, CMS required the use of JW and JZ modifiers for all claims for drugs from single-use vials or single-use packages payable separately under Medicare Part B. The JW modifier is used to identify any discarded amounts. The JZ modifier is used to attest that there were no discarded amounts.
What is a 79 modifier used for?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery. When the procedure is related to the original surgery or is a staged (anticipated) surgery, it falls under the global period and should not use Modifier 79.
What does GX modifier stand for?
Modifier GX
The GX modifier is used to report that a voluntary Advance Beneficiary Notice of Noncoverage (ABN) has been issued to the beneficiary before/upon receipt of their DMEPOS item because the item was statutorily noncovered or does not meet the definition of a Medicare benefit.
What is CPT code 96372 CMS guideline?
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.
Can 99211 and 96372 be billed together?
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.
What is the difference between CPT code 96372 and 90471?
90471 should be used for vaccines and 96372 for drugs. You need to make sure when billing 96372 that you use a 59 modifier on the drug or it won't pay.
How to bill for injectable drugs?
When billing for injectable drugs use a HCPCS code to represent the drug. For example, Depo-Provera (150 mg, for contraceptive use) would be billed using the following codes. J1055: Injection; medroxprogesterone acetate, 150 mg. (HCPCS code is subject to change and is only used as reference example.)
What is 57 modifier?
CPT modifier 57 may be used to report the decision for surgery for certain codes. This modifier may be used to indicate that an evaluation and management (E/M) service performed on the same day or the day before a major surgery (090 global days) by the surgeon resulted in the decision to perform the procedure.
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.