What is the difference between CPT code 20610 and 96372?
Asked by: Mr. Clair Waelchi | Last update: May 28, 2025Score: 4.9/5 (9 votes)
What is procedure code 96372 used for?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
What is the administration code for Dupixent?
For Medicare, Medicaid and their Advantage & Managed care Plans, the Dupixent J Code is J3590. This code is used to bill for the drug when it is administered in a doctor's office or clinic.
What is CPT code 20610 used for?
The 20610 CPT code is used for arthrocentesis, aspiration, and/or injection of a major joint or bursa, such as the shoulder, hip, knee, or subacromial bursa.
Can 96372 be billed with an office visit?
The office visit is billable as 99214-25 Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity, along with the injection, 96372.
CPT 20610 Documentation Requirements
Is 96372 included in 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.
Why is Medicare denying 96372?
Inappropriate or missing modifier. CPT code 96372 is not properly documented, indicating that a procedure or service was distinct or independent from other services performed on the same day. CPT code 96372 is used for certain types of vaccinations. Most vaccinations are typically coded with 90471 or 90472.
What is CPT code 20610 billing guidelines?
The procedure code (CPT code) 20610 or 20611 may be billed for the intraarticular injection. The charge, if any, for the drug or biological must be included in the physician's bill and the cost of the drug or biological must represent an expense to the physician.
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 a CPT code 20610 be billed with 99213?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
How do I get prior authorization for DUPIXENT?
You can obtain the appropriate PA form through DUPIXENT MyWay®, CoverMyMeds®, or your patient's insurance provider or specialty pharmacy. Consider including a letter that explains your patient's condition in detail.
What is the CPT code for biologic injection?
CPT® 96401, Under Injection and Intravenous Infusion Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.
Does Medicare cover DUPIXENT injections?
Medicare Advantage and Part D plans may cover Dupixent for people who have moderate to severe disease. Other options besides Medicare may make Dupixent more affordable, such as Dupixent SingleCare coupons, a manufacturer copay card, and a patient assistance program.
What is the CPT code for Dupixent?
HCPCS J3490 (unclassified drugs) or J3590 (unclassified biologics) are HCPCS codes you can use for Dupixent.
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.
What is the CPT code for filler injection?
Filler Procedures HCPCS Code range G0428-G0429
The HCPCS codes range Filler Procedures G0428-G0429 is a standardized code set necessary for Medicare and other health insurance providers to provide healthcare claims.
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 are the three categories of CPT codes?
- Category I: These codes have descriptors that correspond to a procedure or service. ...
- Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. ...
- Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services.
Do you bill 96372 with 20610?
A patient undergoes a diagnostic injection (96372) for a joint aspiration and also receives an arthrocentesis (20610) during the same visit. Modifier 59 would be added to the 96372 code to indicate that it is separate and distinct from the arthrocentesis procedure.
What does code 20610 mean?
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 CPT code 96372?
The 96372 CPT code is is a procedural code defined as therapeutic, prophylactic, and diagnostic substance by subcutaneous or intramuscular injections and infusions. . While this code is not often used in the mental and behavioral health setting, there are certain specialties that do use it.
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.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.