96372 CPT Code | Description, Guidelines, Reimbursement, Modifiers & Examples

96372 CPT code is used for the administration of any diagnostic, therapeutic, or prophylactic substance (a drug, a fluid, etc.) by a physician or assistant. This is performed under the direct supervision of a physician via the intra-arterial injection (96373), subcutaneous or intramuscular injection (96372) route into the patient’s body.

CPT 96372 can also be administered by a push into an intravascular access device or intravenous catheter (96374 CPT code is used for billing a single or initial substance).

CPT 96374 and 96375 can be billed for each additional sub-sequential IV push of a new substance or the same substance after 30 minutes.

The infusion of less than 15 minutes will be considered a push technique. The vial of a substance, Toxoid, vaccine, or vaccine/toxoid administration is not included in 96372 CPT code and should be separately billed by appropriate CPT and HCPCS Level II codes.

96372 CPT Code Description

The 96372 CPT code description is as follows. CPT 96372 will be billed when a Therapeutic, Diagnostic, or prophylactic substance is injected by a physician or other Healthcare professional by subcutaneous or intramuscular into the patient’s body.

The official description of CPT 96372 is: “Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular.”

It includes direct supervision of the Physician but is not needed when billed by the Hospital. CPT 99211 will be reported instead of 96372 CPT when a substance is injected without a physician’s supervision. It excludes administration of Vaccines or toxoids and is separately billable.

CPT Code 96372 With Modifier 59

Modifier 59 is usually appended with the services or procedures that are distinct and not normally billed together on the same day. We can use modifier 76 or modifier 77 instead of modifier 59 when service or procedure is done on the same anatomical site by the same or different provider, respectively. Documentation should support services that are appended with modifier 59.

These are the following reasons when modifier 59 needs to append with CPT 96372:

When a patient encounters more than one injection on the same day, Then modifier 59 will be appended with each subsequent injection given via intramuscular or subcutaneous. It is done under the Physician’s direct supervision or each subsequent injection.

Modifier Example

A 49-year-old male presented to the office for shoulder pain. He was diagnosed with a respiratory infection during the exam. The Physician gave Vancomycin drug injection for respiratory infection.

In this scenario, we will put modifier 25 with Evaluation and management code (99201-99499) for shoulder pain. In addition, modifier 59 will be attached with CPT 96372 for a Substance or drug injected by a Physician. Therefore, it would be like this:

• (M25.519) ICD, 99214 – 25
• (J06.9) ICD, 96372 – 59
• (J06.9) ICD, J3370

Reimbursement

96372 CPT code is reimbursable when billed alone or in conjunction with other services according to the National Correct Coding Initiative (NCCI) by appending an appropriate modifier if needed.

When Service (CPT 96372) is performed on the same day with Evaluation and management service (CPT Codes 99202-99499) by the same rendering provider, CPT 96372 will not be reimbursable in addition.

However, if any unrelated significantly identifiable evaluation and management services are performed in conjunction with Therapeutic Injection, 96372 CPT is reimbursable. If the Physician provides any medicine, indicate the drug’s dosage and name on the CMS-1500 Box 19 or the comparable loop and section of the 837P.

Cost

The CPT code 96372 cost is as follows:

The RUVS of CPT 96372 was 14.31 in 2020, increasing to 14.44 in 2021. As per current RUVS, The cost of 96372 CPT is 14.44 $ for a Non-facility setting.

Can CPT Code 96372 Be Billed Alone?

Yes, it can be billed alone when the injection is performed alone or in conjunction with other procedures/services as allowed by the National Correct Coding Initiative (NCCI) procedure to procedure editing.

CPT 96372 Medicare

Only specific types of vaccines can be billed with CPT 96372. Most Vaccines are generally reported with 90471-90472. In addition, G codes are billed as administrative codes for Vaccines like flu (CPT G0008).

CPT 96372 Multiple Injections

If multiple injections are given in one visit, each injection should be reported separately. It would be appropriate to append modifier 59 with each subsequent injection. It is reported per injection regardless of more than one substance used in the one injection.

Billing Examples

The following are 5 examples of medical scenarios when it is appropriate to use CPT 96372.

Example 1

A 35-year-old female PMH gastric sleeve presented with dysuria, vaginal itching, and white discharge for the past 2-3 days. The patient reports only having one sexual partner, no fever, chills, headache, changes in vision, chest pain, palpitations, SOB, n/v/d/c, hematuria, lightheadedness, dizziness, or other arms/leg pain. She reports having similar symptoms in the past. UA shows 1+leuk esterase with 300+ bacteria, and the Physician decided to give Diflucan 150mg.

Billing:

Patient: 35F

Diagnoses:

• ICD 10 Z98.84: Bariatric surgery status (gastric sleeve)
• ICD 10 N39.0: Urinary tract infection, site not specified
• ICD 10 B37.3: Candidiasis of vulva and vagina

Procedures:

• CPT 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (Diflucan 150mg)

Example 2

We are presented with a Forty-nine-year-old male with PMH Cerebral Palsy. The patient presents with severe head pain after kneeling forward, slipping, and hitting his head against the wooden cabinet. The Patient denies loc or prodromal symptoms. He is not on any blood thinners. He denies vision changes, numbness, tingling, weakness. The patient also denies f/c, cp, sob, n/v, abdominal pain, dysuria, hematuria. CT and MRI of the Head were done, and the study revealed Migraines. A physician decided to treat migraine with Sumatriptan injection 140mg.

Billing:

Patient: 49M

Diagnoses:

• ICD 10 G80.9: Cerebral palsy, unspecified
• ICD 10 S09.90XA: Unspecified injury of head, initial encounter
• ICD 10 G43.909: Migraine, unspecified, not intractable, without status migrainosus

Procedures:

• CPT 70450: Computed tomography, head; without contrast material
• CPT 70551: Magnetic resonance (e.g., proton) imaging, brain (including brain stem); without contrast material
• CPT 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (Sumatriptan 140mg)

Example 3

A 33M PMH IDDM and HTN, presenting with nausea and vomiting in the context of hyperglycemia. Pt states 1.5 weeks ago that, he began having generalized weakness and pain in his entire body. Starting two days ago, after eating lunch, he began having nausea and vomiting and has been unable to keep down food since.

He also reports shortness of breath worse with movement and lightheadedness on ambulation. On arrival in the ED, his blood glucose was elevated to 600. He denies fevers, chills, chest pain, diarrhea, constipation, abdominal pain, dysuria, numbness, tingling, recent travel, sick contacts.

He is not covid vaccinated. Labs reviewed. Cr 5.6 (an increase from 2.9 last year). AG of 17, WBC 16.5, pH 7.335. Patient not acidotic, likely due to poor kidney function and bicarb retention. Potassium 4.3 will supplement fluids with 3 runs KCl rider. We will also start the patient on insulin drip .1U/kg/hr. Blood pressure elevated to 203/114, and the patient gave home medications Hydralazine 100 and Amlodipine 90. Pt with the elevated white count left shift and elevated lactic will broadly cover with Vancomycin 500mg.

Billing:

Patient: 33M

Diagnoses:

• ICD 10 E10.65: Type 1 diabetes mellitus with hyperglycemia
• ICD 10 I10: Essential (primary) hypertension
• ICD 10 R11.0: Nausea
• ICD 10 R11.2: Nausea with vomiting, unspecified
• ICD 10 R53.81: Other malaise
• ICD 10 R07.89: Other chest pain
• ICD 10 R50.9: Fever, unspecified
• ICD 10 R06.02: Shortness of breath
• ICD 10 R42: Dizziness and giddiness
• ICD 10 N25.89: Other disorders resulting from impaired renal function

Procedures:

• CPT 96372-25-59: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular (insulin drip)
• CPT 96372-59: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular (potassium with 3 runs KCl rider)
• CPT 96372-59: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular (Vancomycin 500mg)

Example 4

Forty-three-year-old male with no significant medical history is presented to the ER for bouts of vertigo and nausea. Per patient, he has had cold flu-like symptoms for approx two weeks. He was given abx, azithromycin, and cefuroxime by his PCP Dr. Naeem. He took meds for four days without issue. Last night awoke with the sensation of the room spinning. He had three such episodes of Symptoms, including when he woke up this AM. Otherwise denies CP, SOB, vomiting, fevers, chills. Nausea and vertigo decided to treat with Zofran 600mg.

Billing:

Patient: 43M

Diagnoses:

• ICD 10 R42: Dizziness and giddiness (vertigo)
• ICD 10 R11.0: Nausea
• ICD 10 R05: Cough
• ICD 10 J11.1: Influenza due to unidentified influenza virus with other respiratory manifestations
• ICD 10 Z23: Encounter for immunization

Procedures:

• CPT 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (Zofran 600mg)

Example 5

57 yo M PMH anterior cervical discectomy, known lumbar stenosis, L shoulder surgery, presenting with 1.5 weeks of L testicular pain radiating into his L groin. He says it is moderate and has not worsened, but it has stayed for a prolonged period, prompting the ER visit. Pain seems to trigger the urge to use the bathroom for urinating and defecating. The pain is moderately relieved after doing so. The patient tried Aleve with minimal relief. Sexually active with one female partner, they do not use condoms. No urinary changes. Exam revealed severe Urinary tract

Billing:

Patient: 57M

Diagnoses:

• ICD 10 R10.2: Pelvic and perineal pain (L testicular pain radiating into L groin)
• ICD 10 N39.0: Urinary tract infection, site not specified

Procedures:

• CPT 96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (Meropenem and vaborbactam injections)