2025 CPT code 96365
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
Modifiers may be applicable. Modifier 59 may be used to indicate a distinct procedural service. Modifier 25 is used to report a significant and separately identifiable E/M service.
Medical necessity must be established for this service. Documentation should support the clinical rationale for the infusion, showing it is reasonable and necessary for the patient's condition.
In simple words: This code covers the administration of medication through an IV line for up to an hour, for purposes of treatment, prevention, or diagnosis. It doesn't include fluids for hydration or complex medications like chemotherapy.
This code represents the initial intravenous infusion of a substance or drug for therapeutic, prophylactic, or diagnostic purposes, lasting up to one hour.It is not used for hydration, chemotherapy, or other highly complex drug/biologic agent administrations.
Example 1: A patient receives an intravenous antibiotic infusion over 45 minutes for a skin infection. Code 96365 is reported., A patient receives an intravenous infusion of a contrast agent for diagnostic imaging. This would not be reported with 96365 since infusions are inherent to diagnostic imaging., A patient with multiple sclerosis receives a one-hour infusion of a disease-modifying drug. Code 96365 is reported.
Documentation should include the type and amount of drug administered, start and stop times of the infusion, the diagnosis being treated or prevented, and any complications encountered.
- Specialties:Several medical specialties may utilize this code, including infectious disease, neurology, rheumatology, and gastroenterology.
- Place of Service:Office, Outpatient Hospital