What Is CPT Code 96375 and How Is It Billed?
Navigate CPT Code 96375 with confidence. Understand its specifics, when to use it, and how to ensure correct billing for common medical services.
Current Procedural Terminology (CPT) codes are a standardized system used by healthcare providers to describe medical services and procedures for billing and communication purposes. These five-digit numerical codes provide a common language between providers, patients, and insurance payers, simplifying the complex process of healthcare reimbursement. They ensure that the services rendered are accurately documented and understood across the healthcare system. Among the numerous codes, CPT Code 96375 is frequently encountered, particularly in scenarios involving medication administration through injections.
Understanding CPT Code 96375
CPT Code 96375 designates the administration of a therapeutic, prophylactic, or diagnostic injection. It represents “each additional sequential intravenous (IV) push of a new substance or drug.” This code applies when a substance is administered via IV push, meaning the medication is delivered into the bloodstream over a brief period, typically 15 minutes or less. As an add-on code, it cannot be billed independently and must be reported with a primary procedure code.
Appropriate Use of 96375
CPT Code 96375 is appropriately applied when a patient receives a second or subsequent intravenous push of a new medication during the same encounter, following an initial administration. This code covers the service of administering the injection, rather than the medication itself. For instance, in an emergency department setting, if a patient receives an initial IV push of one medication, and then a subsequent IV push of a different medication, the second drug administration would typically be reported with 96375. It is also utilized in post-surgical care when multiple different pain-relieving substances are administered sequentially via IV push.
It ensures proper accounting for each distinct new substance administered sequentially through an intravenous route. The code reflects the additional clinical effort involved in preparing and administering a new drug after an initial one, rather than a continuous infusion. The sequential nature means the administration of the new substance begins after the previous one has concluded.
Distinguishing 96375 from Other Services
CPT Code 96375 is specific to the administration service and does not include the cost of the drug or vaccine product itself. These products are billed separately using codes like HCPCS Level II. For example, CPT Code 96374 is used for the initial intravenous push of a single substance or drug.
Code 96375 differs from subcutaneous or intramuscular injections, which are reported with CPT Code 96372. It also does not apply to intravenous infusions that run for longer periods, nor to chemotherapy administration. If the same drug is administered sequentially more than 30 minutes after an initial push of that same drug, CPT code 96376 may be used instead of 96375. Services like local anesthesia, starting an IV, or standard supplies are considered bundled into the administration code and are not separately billable.
Billing and Documentation for 96375
When billing CPT Code 96375, it is reported once for each additional sequential intravenous push of a new substance or drug. As an add-on code, it must be billed with an appropriate primary code, such as 96365 (initial IV infusion), 96374 (initial IV push), or certain chemotherapy administration codes. Failure to include a primary code will result in claim denials. The order of drug administration can influence the primary code choice, but 96375 is always for subsequent, new substances.
Accurate documentation in the medical record is essential to support the use of CPT Code 96375. This documentation should include the specific name of each drug administered, its dosage, route (e.g., IV push), exact time of administration, and medical necessity. Recording the sequence of administration is also important for justifying the “additional sequential” aspect of the code. Proper documentation ensures compliance with billing regulations and facilitates appropriate reimbursement.