Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. IV push billed without drug supply code or timing documentation
Very Common96374 (IV push, single or initial drug) requires: (1) drug supply code (J-code), (2) documentation of IV push administration method (not drip infusion), AND (3) push timing <15 minutes. If drug administered over 15+ minutes, should bill as infusion (96365) not push. Must document push technique and duration to support 96374.
Common Causes
- • Only admin code billed - no J-code for drug product
- • Documentation states 'IV medication given' - doesn't specify push vs infusion method
- • Drug pushed over 20 minutes - exceeds 15-minute push threshold, should be infusion code
Resolution Strategy
Document IV push technique: 'Ondansetron 4mg IV push over 5 minutes via peripheral IV line.' Must show: (1) IV push method (not infusion), (2) duration <15 minutes, (3) drug name and dose. Bill with drug code: 96374 + J2405 (ondansetron 1mg, x4 for 4mg dose). If drug given over 15+ minutes, rebill as initial infusion 96365. If drug given via IV drip bag, not considered 'push' - use infusion code.
2. Multiple IV push codes billed same day - only initial push separately billable
Common96374 covers initial IV push. Additional sequential IV pushes same day = 96375 (add-on code). Cannot bill multiple 96374 codes same day - only one initial push (96374), then 96375 for each additional push. Billing multiple 96374s triggers denial for duplicate initial service.
Common Causes
- • Two IV pushes same day, both billed as 96374 - should be 96374 + 96375
- • Three IV pushes billed as 96374 x3 - should be 96374 + 96375 x2
- • Different drugs pushed but all coded 96374 - still only one initial, rest are 96375
Resolution Strategy
Rebill correctly: First IV push = 96374, subsequent pushes = 96375 (each additional). Example: Patient receives Zofran push + Decadron push + Pepcid push = bill as 96374 (initial push) + 96375 x2 (two additional pushes) + J-codes for all three drugs. Cannot appeal if multiple 96374 billed same day - must rebill with correct initial + add-on code structure.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For IV push administration of single or initial drug over short period (typically 15 minutes or less)
Common Scenarios
Documentation Requirements
- Drug name and dosage
- IV push administration documented
- Start and stop times
- Patient response to medication
- Medical necessity
Coding Guidelines
Common Modifiers
Bundling Rules
- Drug supply billed separately with J-codes
- IV access not separately billable if only for this injection
- Cannot bill E/M same visit unless significant separately identifiable service
Exclusions
- Infusions over 15 minutes use 96365-96368
- Additional sequential drugs use 96375
- Concurrent drugs use 96376
Coding Notes
Clinical scenarios
- Drug name and dosage
- IV push administration documented
- Start and stop times
- Drug name and dosage
- IV push administration documented
- Start and stop times
- Drug name and dosage
- IV push administration documented
- Start and stop times
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Ask a QuestionFrequently Asked Questions
CPT 96374 is the billing code for "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug". For IV push administration of single or initial drug over short period (typically 15 minutes or less)
Medicare pays approximately $33.96 for CPT 96374 (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 96374 has a total RVU of 1.30, broken down as: Work RVU 0.58, Practice Expense RVU 0.66, and Malpractice RVU 0.06. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 96374 is "IV push billed without drug supply code or timing documentation". 96374 (IV push, single or initial drug) requires: (1) drug supply code (J-code), (2) documentation of IV push administration method (not drip infusion), AND (3) push timing <15 minutes. If drug administered over 15+ minutes, should bill as infusion (96365) not push. Must document push technique and duration to support 96374. Common causes include: Only admin code billed - no J-code for drug product; Documentation states 'IV medication given' - doesn't specify push vs infusion method. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 96374 include: Drug name and dosage; IV push administration documented; Start and stop times; Patient response to medication. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 96374: Drug supply billed separately with J-codes. IV access not separately billable if only for this injection Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 96374 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 96374 is 5-15 minutes typical administration time. Time-based codes require documentation of the actual time spent providing the service.