2025 CPT code 96367
(Active) Effective Date: N/A Revision Date: N/A Therapeutic, Prophylactic, Diagnostic Injections and Infusions - Intravenous Infusion Medicine Feed
Additional sequential intravenous infusion of a new drug/substance, up to 1 hour; reported in addition to the primary procedure code.
Modifiers may be applicable depending on the circumstances.Refer to the CPT manual and NCCI edits for guidance.
The medical necessity of the sequential infusion must be clearly documented in the patient's record.This documentation should explain why an additional infusion was necessary and how it contributed to the patient's treatment.
The physician or other qualified healthcare professional is responsible for ordering the infusion, supervising its administration, and ensuring patient safety.The nurse or other qualified medical personnel will administer the infusion under direct supervision.
In simple words: This code is for an extra IV drip of a different medicine given after the first one, through the same IV line. It only covers the second medicine, lasting up to an hour. The doctor will use a main code for the first medicine.
This code reports an additional sequential intravenous infusion of a new drug or substance, lasting up to one hour.It's used when a new medication is administered after an initial infusion through the same IV access. This code is an add-on code and requires a primary procedure code (e.g., 96365, 96374, 96409, 96413) to be reported along with it. The infusion must be of a different substance than the primary infusion.Only one unit of 96367 is reported per sequential infusion of the same infusate mix, regardless of the number of hours.
Example 1: A patient receives an initial one-hour infusion of antibiotics (96365). After the first infusion, they receive a second infusion of a different antibiotic, lasting 45 minutes (96367). This second infusion treats a secondary infection., A patient receives an initial IV push of pain medication (96374) followed 30 minutes later by an additional infusion of anti-nausea medication (96367) to manage post-operative symptoms. This additional infusion runs for 50 minutes., A patient is undergoing chemotherapy.The initial infusion is a one-hour chemotherapy drug (96413).Afterwards a prophylactic medication is given as a sequential infusion for 30 minutes (96367) to reduce side effects.
* Documentation of the initial infusion service and the primary code used* Drug names and dosages for both the initial and sequential infusions* Infusion start and stop times for both infusions* Medical necessity for both infusions, particularly if exceeding the maximum allowable units* Physician's order and appropriate signatures
** * Always verify payer-specific guidelines for this code, as allowable units and reimbursement policies may vary.* The maximum number of allowable units for this code may be restricted by some payers.* Accurate documentation is critical for proper reimbursement.
- Revenue Code: P6C (Minor Procedures - Other)
- RVU: Information not available in source.Consult the AMA CPT codebook or other relevant fee schedules for RVU values.
- Global Days: Not applicable. This is an add-on code for a single infusion.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is an add-on code for an infusion.
- Fee Schedule: Information not available in sources.Consult relevant fee schedules for historical data.
- Specialties:Oncology, Hematology, Internal Medicine, Emergency Medicine
- Place of Service:Office, Hospital Outpatient, Ambulatory Surgical Center, other outpatient settings