CPT codes, known as Current Procedural Terminology, streamline healthcare communication, ensure accurate billing, and adapt to evolving services. They improve patient care and financial workflows, making them an essential tool for efficient, error-free medical service delivery.
What is CPT code 96372?
CPT Code 96372 serves as a procedural identifier for documenting the delivery of therapeutic, preventive, or diagnostic injections or infusions, with the exception of administering chemotherapy or other intricate pharmaceuticals and biologic agents.
When should CPT Code 96372 be used?
- Pain medications
- Hormone therapies
- Immunotherapy drugs
- Biologic agents
How do I bill for CPT Code 96372?
You will need to submit a claim to your payer with the following information:
- Patient’s name and date of birth
- Service date
- Provider’s name and NPI number
- Quantity of injections or infusions administered
- Name of the drug or substance administered
Also read: 11055 CPT Code Description
What are the requirements for 96372 reimbursement?
You must meet the following criteria.
- The injection or infusion must be administered under the direct supervision of a qualified healthcare provider.
- Be medically necessary
- Documented in the patient’s medical record.
What are some common examples of 96372 code usage?
Patients receive injections for various medical conditions, including bacterial infections, migraines, joint pain, menopause, cancer treatment, and Crohn’s disease.
What are some of the most common reasons why claims for code 96372 are denied?
The claims may be denied due to the following:
- Unnecessary injection/infusion
- Lack of supervision/documentation
- Incorrect code/quantity
- Payer policy restrictions
How do we avoid claims denial?
To avoid CPT Code 96372 claim denials:
- Ensure medical necessity and supporting documentation
- Administer under a qualified healthcare provider’s direct supervision
- Document injection/infusion in patient’s medical record
- Submit claims with the correct CPT code and quantity
- Stay informed about specific payer policies.
1. What is the difference between a CPT code and a HCPCS code?
A: Healthcare providers use Current Procedural Terminology (CPT) codes to describe medical procedures and services for billing and reimbursement purposes. Healthcare Common Procedure Coding System (HCPCS) codes report medical supplies and services not covered by CPT codes. Non-physician healthcare providers also use HCPCS codes. These codes ensure accurate and efficient billing and reimbursement for medical services.
2. Does CPT code 96372 include the cost of the medication?
Yes, It includes the medication or vaccine cost, any necessary supplies, and the administration process.
3. Is this code specific to a particular type of injection?
No, it is not specific to a particular type of injection and covers both intramuscular and subcutaneous injections.
4. Can healthcare providers use CPT 96372 for multiple injections during a single visit?
Yes, healthcare providers can use it for each separate injection administered during a single visit.
5. Are there any age restrictions for using this code?
There are no age restrictions for using this code.
6. Are there any special considerations for billing for Medicare patients?
Providers must adhere to Medicare’s specific guidelines when billing the 96372 code.
7. How do insurance companies reimburse services reported under CPT code 96372?
Insurance companies and specific insurance plans have varying reimbursement rates.
8. Can nurses or medical assistants administer injections under this code?
Yes, both can administer injections under the supervision of a licensed healthcare provider.
9. Is prior authorization required for using the CPT 96372 code?
It may vary depending on the insurance company and the specific treatment.
10. Can patients be billed separately for the injection and the medication when using this code?
No, it includes both the injection cost and the medication or vaccine. Patients should not receive separate bills for these components.