Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Add-on infusion code billed without initial infusion or required drug codes
Very Common96376 (additional sequential infusion substance) is add-on code requiring: (1) initial infusion code 96365 same day, (2) drug supply codes for all substances, AND (3) documentation of sequential administration (not concurrent). Cannot bill 96376 without initial infusion same day. Each substance requires separate J-code.
Common Causes
- • 96376 billed but no initial infusion code 96365 present - add-on without base code
- • Only one drug infused - should be 96365 only, not 96365 + 96376
- • Two drugs infused concurrently (Y-site connector) - both 96365, not 96365 + 96376
Resolution Strategy
Document sequential infusion: 'Normal saline 1L IV over 60 min (11:00-12:00), followed by ondansetron 8mg IV infusion over 15 min (12:10-12:25).' Bill: 96365 (initial infusion, saline) + 96376 (additional sequential infusion, ondansetron) + J7030 (saline) + J2405 (ondansetron). If drugs given concurrently, both count as initial - bill two 96365 codes (if both medically necessary primary drugs). If only one drug infused, bill 96365 only.
Relative Value Units (RVUs)
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Clinical Information
When to Use
For each additional sequential IV push of the same drug previously administered, typically in facility setting
Common Scenarios
Documentation Requirements
- Drug name and dosage for each push
- Timing of each administration
- Same drug as initial push documented
- Medical necessity for repeat dosing
Coding Guidelines
Common Modifiers
Bundling Rules
- Must report with 96374
- Add-on code listed separately
- Typically facility reporting
Exclusions
- Different drug uses 96375
- Initial push uses 96374
- Concurrent different drug uses different code
Coding Notes
Clinical scenarios
- Drug name and dosage for each push
- Timing of each administration
- Same drug as initial push documented
- Drug name and dosage for each push
- Timing of each administration
- Same drug as initial push documented
- Drug name and dosage for each push
- Timing of each administration
- Same drug as initial push documented
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Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
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Ask a QuestionFrequently Asked Questions
CPT 96376 is the billing code for "Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility". For each additional sequential IV push of the same drug previously administered, typically in facility setting
CPT 96376 has a total RVU of 0.83, broken down as: Work RVU 0.37, Practice Expense RVU 0.42, and Malpractice RVU 0.04. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 96376 is "Add-on infusion code billed without initial infusion or required drug codes". 96376 (additional sequential infusion substance) is add-on code requiring: (1) initial infusion code 96365 same day, (2) drug supply codes for all substances, AND (3) documentation of sequential administration (not concurrent). Cannot bill 96376 without initial infusion same day. Each substance requires separate J-code. Common causes include: 96376 billed but no initial infusion code 96365 present - add-on without base code; Only one drug infused - should be 96365 only, not 96365 + 96376. Appeal success rate is approximately 40-60%.
Key documentation requirements for CPT 96376 include: Drug name and dosage for each push; Timing of each administration; Same drug as initial push documented; Medical necessity for repeat dosing. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 96376: Must report with 96374. Add-on code listed separately Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 96376 include: 59 (Distinct procedural service if applicable). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 96376 is 5-10 minutes per additional push. Time-based codes require documentation of the actual time spent providing the service.