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Infusion & Injection Guidelines

The Centers for Medicare and Medicaid Services (CMS) make frequent changes to hospital coding and payment regulations.

Infusion and injection coding is often confusing and very complex. The following table presents some guidelines to assist in charging for these services.

Hydration/Therapeutic Infusion/Injection
CPT Codes
Charging Guidelines
96360 – HYDRATION IV INFUSION; INITIAL 31 MINUTES TO 1 HOURIV infusion of prepackaged fluids and/or electrolytes 31-90 minutes
Do not report if the hydration infusion lasts less than 30 minutes
Start and stop time documentation should be documented
96361 – HYDRATION IV INFUSION; EACH ADDITIONAL HOURIV infusion of prepackaged fluids and/or electrolytes >91 minutes
Report for hydration infusion intervals greater than 30 minutes beyond 1 hour increments
Start and stop time documentation should be documented
96365 – IV INFUSION; INITIAL UP TO 1 HOURIV infusion of medications 16-90 minutes
Start and stop time documentation should be documented
96366 – IV INFUSION; EACH ADDITIONAL HOURIV infusion of medications >91 minutes
Report for IV infusion intervals greater than 30 minutes beyond 1 hour increments
Start and stop time documentation should be documented
96367 – SEQUENTIAL INFUSION; UP TO 1 HOURIV infusion of a DIFFERENT medication 1 hour or less after the initial infusion
Report CPT 96367 only once per sequential infusion of the same medication
Start and stop time documentation should be documented
96368 – CONCURRENT INFUSIONMultiple drugs are infusing through the same IV site at the same time (not medications mixed in the same bag) – Charge once
Start and stop time documentation should be documented
96372 – INTRAMUSCULAR/SUBCUTANEOUS INJECTIONCharge for each injection
Do not use for the administration of vaccines (see CPT 90460/90461/90471/90472)            
96374 – IV PUSH; SINGLE/INITIAL SUBSTANCE OR DRUGIV push of first drug 0-15 minutes
This is to be used if no documented infusion stop time
Start and stop time documentation should be documented
96375 – IV PUSH; NEW SUBSTANCE OR DRUG IV push of each different drug 0-15 minutes
Start and stop time documentation should be documented
96376 – IV PUSH; SAME SUBSTANCE OR DRUGIV push of same drug 0-15 minutes
Do not report for a push performed within 30 minutes of a reported push of the same substance or drug
Start and stop time documentation should be documented
96369 – SUBCUTANEOUS INFUSION; INITIAL UP TO 1 HOURSubcutaneous infusion 16-90 minutes
CPT 96372 is to be used for subcutaneous infusions lasting less than 16 minutes
Start and stop time documentation should be documented
96370 – SUBCUTANEOUS INFUSION; EACH ADDITIONAL HOUR Subcutaneous infusion >91 minutes
Report for subcutaneous infusion intervals greater than 30 minutes beyond 1 hour increments
Start and stop time documentation should be documented
96371 – SUBCUTANEOUS INFUSION; ADDITIONAL PUMP SET-UP WITH ESTABLISHMENT OF NEW INFUSION SITEAdditional subcutaneous infusion with new subcutaneous infusion site
96373 – INTRA-ARTERIAL INJECTIONCharge for each injection

Hierarchy

When selecting the initial infusion/injection services, it is not the first one performed but rather based on the following hierarchy:

  1. CPT 96365 – IV Infusion
  2. CPT 96374 – IV Push
  3. CPT 96360 – Hydration IV Infusion

Included Services

According to CMS and the AMA, the following services are not separately billable when performed to facilitate an infusion or injection:

  • Use of local anesthesia
  • IV start
  • Access to indwelling IV or subcutaneous catheter or port
  • Flush at the conclusion of the infusion
  • Standard tubing, syringes and supplies
We at CPI Experts are readily available to assist you with your charge process improvement needs.

Whether you require an assessment of your needs, internal education, or an outsourcing partner for your charge master management, CPI Experts can scale its solutions and expertise to fit your organization.

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