Why is Medicare denying 96372?

Can 96372 be billed to Medicare?

Medicare uses G0008 as the administration code for flu vaccinations. Procedure code 96372 is billed for injections related to the provision of chemotherapy services. The proper CPT code to use is 96401-96402.

Can cpt code 99214 and 96372 be billed together?

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 Medicare guidelines for modifier 25?

Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.

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.

When not to use modifier 25?

Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.

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 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?

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.

Does UHC cover CPT 96372?

A: Yes, UnitedHealthcare would reimburse for both the HCPCS drug code and the Injection or Infusion code (CPT 96360-96379) under the guidelines of this policy.

When can a right, left, or bilateral modifier be reported with a CPT code?

Reporting these bilateral-indicator-1 procedures with either LT or RT and 1 unit of service is appropriate only if the procedure is being performed unilaterally. If the procedure is performed bilaterally, modifier 50 should be appended to the procedure code with 1 unit of service.

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.

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.

How much does Medicare reimburse for an office visit?

Beyond that, Medicare Part B covers 80% of the Medicare-approved cost of medically necessary doctor visits. The individual must pay 20% to the doctor or service provider as coinsurance. The Part B deductible also applies, which is $257 in 2025.

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 procedure code 96372 used for?

CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.

What is the modifier 26 for Medicare?

Modifier 26 is appended to billed codes to indicate that only the professional component of a service/procedure has been provided. It is generally billed by a physician. Services with a value of “1” or “6” in the PC/TC Indicator field of the National Physician Fee Schedule may be billed with modifier 26.

Can you bill an E&M with an injection?

You may bill both the injection and the E/M service (with modifier 25 appended). The diagnoses underlying the E/M and the injection (or other minor procedure) may be the same, or different.

Can I bill 96372 with an office visit?

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.

How many units can you bill for 96372?

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.

What is the billing rule for 99214?