Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Intra-arterial injection billed without supporting documentation
Common96373 (intra-arterial injection) requires documentation of arterial access, drug administration into artery (not vein), and medical necessity for arterial route. Denied when documentation doesn't clearly specify arterial administration or when subcutaneous/IM route used instead. Much less common than IV/IM - payers audit heavily.
Common Causes
- • Documentation states 'injection given' without specifying arterial route
- • Arterial line in place but drug given IV through peripheral line
- • Billed 96373 for routine injection - should be 96372 (IM/SQ) instead
Resolution Strategy
Document arterial administration explicitly: 'Medication administered via intra-arterial route through existing arterial line (radial artery)' OR 'Direct intra-arterial injection performed into femoral artery under fluoroscopic guidance.' Include drug name, dose, arterial access site, and medical necessity (e.g., chemotherapy requiring arterial delivery for targeted perfusion). If injection actually given IM/SQ/IV, rebill with correct admin code (96372 for IM/SQ, 96374 for IV push). Cannot appeal if documentation doesn't support arterial route.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For intra-arterial injection of therapeutic, prophylactic, or diagnostic substance
Common Scenarios
Documentation Requirements
- Substance/drug injected
- Route documented as intra-arterial
- Dosage administered
- Arterial access site
- Medical necessity for intra-arterial route
Coding Guidelines
Common Modifiers
Bundling Rules
- Drug supply billed separately
- Cannot bill with E/M unless separately identifiable
- Arterial access may be separately billable
Exclusions
- Subcutaneous/IM uses different codes
- IV push/infusion uses 96374-96379
- Anesthesia administration excluded
Coding Notes
Clinical scenarios
- Substance/drug injected
- Route documented as intra-arterial
- Dosage administered
- Substance/drug injected
- Route documented as intra-arterial
- Dosage administered
- Substance/drug injected
- Route documented as intra-arterial
- Dosage administered
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 96373 is the billing code for "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial". For intra-arterial injection of therapeutic, prophylactic, or diagnostic substance
Medicare pays approximately $18.44 for CPT 96373 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 96373 has a total RVU of 3.18, broken down as: Work RVU 1.42, Practice Expense RVU 1.62, and Malpractice RVU 0.14. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 96373 is "Intra-arterial injection billed without supporting documentation". 96373 (intra-arterial injection) requires documentation of arterial access, drug administration into artery (not vein), and medical necessity for arterial route. Denied when documentation doesn't clearly specify arterial administration or when subcutaneous/IM route used instead. Much less common than IV/IM - payers audit heavily. Common causes include: Documentation states 'injection given' without specifying arterial route; Arterial line in place but drug given IV through peripheral line. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 96373 include: Substance/drug injected; Route documented as intra-arterial; Dosage administered; Arterial access site. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 96373: Drug supply billed separately. Cannot bill with E/M unless separately identifiable Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 96373 include: 59 (Distinct procedural service), 76 (Repeat procedure by same physician). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 96373 is 15-20 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.