What is the difference between 20610 and 96372?
Asked by: Jacynthe Klein DDS | Last update: January 4, 2026Score: 4.1/5 (3 votes)
What is the difference between CPT code 20610 and 96372?
One is for an intramuscular or sub-q injection and one is for an injection or aspiration of a major joint or bursa. They are very clearly 2 separate procedures.
What is procedure code 96372 used for?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
Is 20610 an admin code?
The 20610 CPT code is used in medical procedures involving arthrocentesis, aspiration, and/or injection of major joints or bursae. This code is primarily utilized to remove fluid from joints for diagnostic analysis or to administer medication for pain relief and inflammation reduction.
Why is Medicare denying 96372?
One of the top reasons for medical billing denials is the absence or misuse of modifiers on CPT code 96372, which can lead to a Denial Code 4 from insurers. To prevent this from happening, medical providers and coders must consistently report the correct codes while using a modifier that matches.
CPT 20610 Billing Scenarios
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.
What is cpt code 20610?
CPT code 20610 is used for a procedure where a healthcare provider drains fluid from or injects medication into a joint or bursa without using ultrasound guidance. This code typically applies to treatments for conditions like arthritis or bursitis to relieve pain and inflammation.
What is the 59 modifier used for?
Modifier 59 Distinct Procedural Service indicates that a procedure is separate and distinct from another procedure on the same date of service. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
Can you bill an office visit with a joint injection?
Answer: Unfortunately, no. 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.
What is the difference between CPT code 96372 and 90471?
The main difference is that 96372 is for therapeutic or diagnostic injections, while 90471 is used specifically for immunization administration. CPT 90471 applies to vaccines, whereas 96372 is used for medications or other substances not classified as vaccines.
Does a 96372 need 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.
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.
How to bill for dupixent injection?
HCPCS code J0517 (1MG) is the code to bill for Fasenra. HCPCS J3490 (unclassified drugs) or J3590 (unclassified biologics) are HCPCS codes you can use for Dupixent.
What is the 96372 CPT code used for?
The Current Procedural Terminology (CPT®) code 96372 as maintained by American Medical Association, is a medical procedural code under the range - Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration).
What is the CPT code for joint injection administration?
The CPT codes for arthrocentesis aspiration or injection procedures are 20600-20611. Accurate reimbursement depends on reporting the services provided using all the appropriate code sets and modifiers.
Can you code 96372 twice?
Answer: CPT code 96372… should be reported for each intramuscular (IM) injection performed. Therefore, if two or three injections are performed, it would be appropriate to separately report code 96372 for each injection.
Can you bill 20610 and 96372 together?
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.
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.
Are joint injections covered by insurance?
This procedure is done by specialists — usually an orthopaedic surgeon or sports medicine doctor — who offer the service. It can be given as a one-time shot or done once a week for three weeks. It generally is not covered by insurance, and costs up to $2,000 for the series.
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.
What is a TC modifier?
Modifier TC is used when only the technical component (TC) of a procedure is being billed when certain services combine both the professional and technical portions in one procedure code. Use modifier TC when the physician performs the test but does not do the interpretation.
Do you need a modifier for 20610?
The appropriate site modifier (RT or LT) must be appended to CPT code 20610 or CPT code 20611 to indicate if the service was performed unilaterally and modifier (-50) must be appended to indicate if the service was performed bilaterally.
Can you bill 99213 with 20610?
Use the E/M code with a modifier (for example, 99213-25), as well as the knee joint aspiration procedure code 20610. Thus, when a new problem requires more than a cursory review, the visit generally qualifies for an E/M with modifier -25.
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.