Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Add-on code 96375 billed without initial IV push code 96374
Very Common96375 (additional sequential IV push) is an add-on code - can ONLY be billed with initial IV push 96374 same day. Cannot bill 96375 alone or as first push. Billing 96375 without 96374 = automatic denial as standalone add-on code.
Common Causes
- • Second IV push of day billed, but first push not coded (missed 96374)
- • Billed 96375 assuming it's standalone code for any IV push
- • 96374 denied - 96375 also denied as dependent code
Resolution Strategy
Verify initial IV push 96374 billed same day. If 96374 missing, add to claim: bill 96374 (initial push) + 96375 (additional sequential push). If only one IV push given total, bill 96374 only (drop 96375). If pushes given on different dates, bill each as separate 96374 (new initial push each date). Cannot appeal 96375 without 96374 same encounter - must rebill correctly.
Relative Value Units (RVUs)
Calculator →
Clinical Information
When to Use
For each additional sequential IV push drug given after initial drug coded with 96374
Common Scenarios
Documentation Requirements
- Each drug name and dosage
- Sequential administration documented
- Timing of each push
- Order of administration
Coding Guidelines
Common Modifiers
Bundling Rules
- Must report with 96374
- List separately add-on code
- Each drug billed separately
Exclusions
- First drug uses 96374
- Concurrent administration uses 96376
- Infusions use different codes
Coding Notes
Clinical scenarios
- Each drug name and dosage
- Sequential administration documented
- Timing of each push
- Each drug name and dosage
- Sequential administration documented
- Timing of each push
- Each drug name and dosage
- Sequential administration documented
- Timing of each push
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 96375 - pricing, bundling rules, or billing questions.
Ask a QuestionFrequently Asked Questions
CPT 96375 is the billing code for "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug". For each additional sequential IV push drug given after initial drug coded with 96374
Medicare pays approximately $14.23 for CPT 96375 (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 96375 has a total RVU of 0.92, broken down as: Work RVU 0.41, Practice Expense RVU 0.47, and Malpractice RVU 0.04. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 96375 is "Add-on code 96375 billed without initial IV push code 96374". 96375 (additional sequential IV push) is an add-on code - can ONLY be billed with initial IV push 96374 same day. Cannot bill 96375 alone or as first push. Billing 96375 without 96374 = automatic denial as standalone add-on code. Common causes include: Second IV push of day billed, but first push not coded (missed 96374); Billed 96375 assuming it's standalone code for any IV push. Appeal success rate is approximately 10-30%.
Key documentation requirements for CPT 96375 include: Each drug name and dosage; Sequential administration documented; Timing of each push; Order of administration. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 96375: Must report with 96374. List separately add-on code Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 96375 include: 59 (Distinct procedural service if needed). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 96375 is 5-10 minutes per additional drug. Time-based codes require documentation of the actual time spent providing the service.