CPT code 96372 is commonly used in the healthcare industry for billing purposes. This code represents the administration of a therapeutic, prophylactic, or diagnostic injection (specify substance or drug). Healthcare providers need to thoroughly understand the 96372 CPT code to ensure that they are billing correctly and maximizing reimbursement.
Knowing when and how to utilize CPT 96372 Code may help you streamline your billing process. Accurate medical coding is the cornerstone of a physician’s job when billing for patient services. As a result, it’s critical that you reimburse your services as soon as feasible.
A medical coder must understand how to use CPT code 96372 to appropriately charge for the services you give to your patients.
What exactly is CPT CODE 96372?
The CPT 96372 code relates to any medicine, fluid, or other diagnostic, therapeutic, or prophylactic substance provided by a doctor or assistant. Injections took place subcutaneously (96372), intravenously (96373), and intramuscularly (96374). (96372).
It can also be delivered for infusion through an intravenous catheter or intravascular access device (96374 CPT code is used for billing a single or initial substance). Patients may charge for further follow-up IV pushes after 30 minutes using CPT 96375 or 96374.
Type of Injection; CPT Code 96372
The first step in understanding CPT 96372 knowing the type of injection t it represents. A therapeutic injection is used to treat a specific condition or symptom, while a prophylactic injection is used to prevent a potential illness or condition. A diagnostic injection, on the other hand, identifies a medical condition or measures the effectiveness of a specific treatment.
It is also important to note that CPT code 96372 only covers the administration of the injection and does not include the cost of the medication itself. This means that healthcare providers will need to bill separately for the cost of the medication used in the injection.
When billing for CPT code 96372, it is essential to provide a detailed description of the type of injection given and the specific substance or drug used. This information is critical for ensuring accurate reimbursement and preventing denials or payment delays.
Understanding the timely NCCI Revisions
In addition to the information mentioned above, healthcare providers should also be aware of any relevant National Correct Coding Initiative (NCCI) edits that may affect the billing of CPT code 96372. NCCI edits are used to prevent improper coding and ensure that healthcare providers are billing for services in a manner consistent with industry standards.
In conclusion, CPT 96372 is a critical code for healthcare providers to understand for billing purposes. A thorough understanding of the type of injection represented by this code, the need to bill separately for the cost of the medication, and the importance of providing detailed information about the injection and any relevant NCCI edits, will help ensure accurate reimbursement for healthcare providers.
What are the reimbursement guidelines for CPT code 96372?
CPT code 96372 refers to a therapeutic, prophylactic, or diagnostic injection (specifying substance or drug), intravenous push, or continuous infusion. The reporting of the delivery of a drug by an intravenous injection requires the use of this code. Individual insurance companies are allowed to adjust the Medicare Physician Fee Schedule for reimbursement of this service. Using the Medicare Physician Fee Schedule Lookup tool, you can determine how much Medicare will pay for CPT 96372.
Providers should keep in mind that the Medicare price schedules they use as a guide are not always indicative of the actual reimbursement they will get. Insurance companies may use different methodologies and payment policies, so it’s important to check with the specific payer for their reimbursement policies and procedures. Additionally, the reimbursement for CPT 96372 may vary based on the state and location of service.
In summary, while the Medicare Physician Fee Schedule can provide a general idea of the reimbursement for CPT code 96372, the actual reimbursement amount may vary based on the insurance company, location, and other factors.
Related 96372 CPT Codes
The following codes are very similar to CPT code 96372, including:
CPT 96375 – Intravenous administration of a fresh drug or chemical for therapeutic, diagnostic, or preventative purposes
CPT 96374 – Intravenous push injection of a single or initial drug or substance for therapeutic, diagnostic, or preventative purposes
CPT 96373: Therapeutic, diagnostic, or preventative intra-arterial injection,
CPT 96377 – Application of an on-body injector, such as the insertion of a cannula, for therapeutic, diagnostic, or prophylactic injection.
CPT 96376 – Therapeutic, diagnostic, or prophylactic injection of the same drug or substance administered intravenously again or again
USE OF Modifier with CPT 96372
It is possible to add additional information about the service provided by using various HCPCS or CPT modifiers to CPT 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular).
Some common modifiers used with CPT code 96372 are:
-59 (Distinct procedural service): used to indicate that the injection was performed on a separate body site or distinct lesion.
-51 (Multiple procedures): utilized for simultaneous surgeries.
-XE (Separate Encounter): aimed to differentiate the injectable service from other services rendered on the same day or during the same encounter.
-XS (Separate Structure): used to indicate that the injection was performed on a separate anatomic structure from other services provided.
Payers review modifiers to determine appropriate reimbursement based on the additional information they provide about the service provided.
How can NEO MD handle medical billing and coding?
Our dedicated Medical Billing and Coding experts can help you grow your business. In order to maximize compensation, our team monitors all 96372 CPT Coding rules. Fast, accurate, and error-free coding of each claim in real-time, together with early evaluation to assure claim eligibility, greatly reduces the likelihood of claim denial and refusal.
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What Makes Us the Best Medical Billing Company?
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Let’s Schedule a Demo to learn more about how we can improve your medical practice management. Get us at! (email@example.com) or (929) 502-3636).