2025 CPT code 96379
Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion.
Modifiers may be applicable depending on the specific circumstances. Consult the CPT manual and payer-specific guidelines for appropriate modifier usage.
Medical necessity must be clearly documented and supported by the patient's clinical condition. The documentation must justify the use of the unlisted code rather than a specific CPT code, demonstrating that no other code accurately reflects the procedure performed.
The provider is responsible for the overall plan of care, direct supervision of staff administering the infusion/injection, assessment of the patient, obtaining consent, and ensuring patient safety throughout the procedure.
- Medicine Services and Procedures
- This code falls under the broader category of Medicine Services and Procedures, specifically within the subcategory of Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.
In simple words: This code is for IV or intra-arterial injections or infusions (like giving medicine or fluids through a vein or artery) that don't have a specific medical billing code. It's used when the treatment doesn't fit any of the existing codes.
This CPT code reports therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion procedures that do not have a specific code.It's used when no other CPT code accurately reflects the service provided.The procedure may involve administering medication, fluids, electrolytes, or nutrition intravenously or intra-arterially for diagnostic, therapeutic, or prophylactic purposes.
Example 1: A patient receives an experimental drug via intravenous infusion for a clinical trial. No other CPT code accurately describes this administration., A patient with a rare condition receives a unique combination of medications delivered intravenously. No existing CPT code perfectly fits this specific combination., A patient requires a diagnostic infusion of a specific contrast agent not covered under any existing CPT code, delivered intra-arterially for a specialized imaging technique.
Detailed documentation is crucial for reimbursement.This should include the reason for the unlisted code, the specific drug(s) administered, the route of administration (intravenous or intra-arterial), the dosage, the total infusion time, the patient's response, and any complications.Comparison to similar CPT codes and justification for using this unlisted code are necessary.
** When using this unlisted code, submit a detailed explanation to the payer justifying the selection of 96379.Include similar CPT codes for comparison and extensive clinical documentation.
- Revenue Code: P6C (MINOR PROCEDURES - OTHER)
- RVU: Not specified; reimbursement depends on documentation and payer-specific policies.
- Global Days: Not applicable; this is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: The TC modifier may or may not apply depending on the specific service and payer requirements.Physician judgment and payer policy should guide the modifier's use.
- Fee Schedule: Fee schedule information is not provided, and will vary by payer and geographic location. Reimbursement depends on individual circumstances and adequate documentation.
- Specialties:Many specialties may utilize this code, depending on the clinical indication for the intravenous or intra-arterial injection or infusion. This would depend on the specific clinical context of the procedure, such as cardiology, oncology, critical care, and others.
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, Inpatient Hospital, other locations as medically necessary.