96372 cpt code

96372 CPT Code (2022) – 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 body of the patient.

It also can 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 IV push of the same substance, respectively, after 30 minutes elapsed.

The infusion that is 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. 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 96372 Billing Guidelines


This is the following list of modifiers that is appropriate to append with CPT 96372:

  • 22, 51, 52, 58, 59, 76, 77, 78, 79, 89, AI, CC, CR, ET, EY, GA, GC, GJ, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, XE, XP, XS, XU
  • Most frequently the modifiers are 59, 76, 77 billed with 96372 CPT.
  • Modifier 25 will be appended with Evaluation and Management CPT codes (99201-99499) when these services are unrelated to injection (96372 CPT code).
cpt 96372
96372 CPT code is used for the administration of any diagnostic, therapeutic, or prophylactic substance by a physician or assistant.

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 77 instead of 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:

  1. 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.

    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.

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.

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.

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 not been able 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.

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.

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 infection. The Physician treats with Meropenem and vaborbactam injections.

Can CPT Code 96372 Be Billed Alone?


Yes, it is allowed to 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.

cpt 96372
96372 CPT Code Description

By Uzair Ali Murtaza
Expert Medical Coding & Billing

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2 Comments

  1. Donna Gingras says:

    Does the anatomical site have to be documented to bill for 96372

    1. Hi Donna,

      Intramuscular or subcut …There is no specific anatomical site for code 96372.

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