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 HOUR | IV 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 HOUR | IV 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 HOUR | IV infusion of medications 16-90 minutes Start and stop time documentation should be documented |
| 96366 – IV INFUSION; EACH ADDITIONAL HOUR | IV 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 HOUR | IV 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 INFUSION | Multiple 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 INJECTION | Charge for each injection Do not use for the administration of vaccines (see CPT 90460/90461/90471/90472) |
| 96374 – IV PUSH; SINGLE/INITIAL SUBSTANCE OR DRUG | IV 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 DRUG | IV 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 HOUR | Subcutaneous 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 SITE | Additional subcutaneous infusion with new subcutaneous infusion site |
| 96373 – INTRA-ARTERIAL INJECTION | Charge 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:
- CPT 96365 – IV Infusion
- CPT 96374 – IV Push
- 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