2025 CPT code 96366
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
Modifier 59 may be appended to a second instance of 96365 if two separate IV sites are utilized due to protocol or patient condition.
Medical necessity must be established for the continued infusion beyond the first hour. The documentation should support the need for the extended duration of the infusion based on the patient's clinical condition and response to treatment.
The physician or other qualified healthcare professional is responsible for evaluating the patient's condition, ordering the infusion, and supervising the administration of the infusion. This includes patient assessment, obtaining consent, safety oversight, and monitoring vital signs during the infusion.
In simple words: This code covers the additional time spent receiving an IV infusion of medication beyond the first hour, used for treatment, prevention, or diagnosis of a condition.
This code is used for reporting each additional hour of a therapeutic, prophylactic, or diagnostic intravenous infusion.It is an add-on code and must be reported in addition to a primary procedure code, such as 96365 (for the initial hour of infusion). It should be used when the infusion continues beyond the initial hour, and is reported for each additional hour or portion thereof.For infusion intervals exceeding 30 minutes beyond 1-hour increments, this code should be used.
Example 1: A patient receives a continuous IV infusion of antibiotics for 3 hours. The initial hour is reported with 96365, and the subsequent 2 hours are reported with two units of 96366., A patient receives an infusion of medication over 1 hour and 45 minutes.96365 is reported for the first hour, and 96366 is reported once for the additional 45 minutes., A patient receives two sequential IV infusions, one for 1 hour and a second one for 2 hours. 96365 is reported for the initial hour of the first infusion. 96367 is reported for the first hour of second infusion, and 96366 is reported once for the additional hour of the second infusion.
Documentation should include the type and amount of drug or substance infused, the start and stop times of the infusion, the rate of infusion, any adverse reactions, and the clinical rationale for continuing the infusion beyond the initial hour.The medical necessity for the prolonged infusion should also be documented.
** For infusions lasting more than one hour, the initial hour would be coded as 96365 and any additional hour would be coded using 96366. Remember to specify the drug infused and only bill one initial infusion code, unless two separate IV sites are used.
- Specialties:This code is relevant to any specialty that administers intravenous infusions, including but not limited to internal medicine, family practice, emergency medicine, and various surgical specialties.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, and other outpatient settings.