Description of 96372 CPT code: Intramuscular and Subcutaneous Injection

The physician or an assistant under direct physician supervision administers a therapeutic, prophylactic, or diagnostic substance by subcutaneous (subq or SQ) or intramuscular 0r IM injection (96372 CPT code), intra-arterial injection (96373), or by push into an intravenous catheter or intravascular access device (96374 for a single or initial substance, 96375 for each additional sequential IV push of a new substance, and 96376 for each additional sequential IV push of the same substance after 30 minutes have elapsed). The push technique involves an infusion of less than 15 minutes. Code 96376 may be reported only by facilities.

96372  Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

The subcutaneous or intramuscular injection have to follow the hierarchy when coded along with injection, infusion and hydration CPT codes.  The hierarchy is followed as below:

IV infusion>IV Push>subcutaneous and intramuscular injection>hydration

This hierarchy is very important in Emergency department (ED) coding. The ED coders need to follow these coding guidelines strictly in ED facility.

As per CMS  NCCI or Medicare guidelines, CPT codes 96372-96379 are not intended to be reported by the physician in the facility setting. Thus, when an E/M service and a therapeutic and diagnostic Injection service are submitted with CMS Place of Service (POS) codes 19, 21, 22, 23, 24, 26, 51, 52, and 61 for the same patient by the Same Individual Physician or Other Health Care Professional on the same date of service, only the E/M service will be reimbursed and the therapeutic and diagnostic Injection(s) are not separately reimbursed, regardless of whether a modifier is reported with the Injection(s).

The IM or SQ injection can be billed more than once or twice. If the drug is prepared and drawn up into two separate syringes and it is then administered in two individual injections in two distinct anatomic sites, you can bill two units of code 96372 (billing second unit with modifier 76). 

Non-Facility Injection Services 

E/M services provided in a non-facility setting are considered an inherent component for providing an Injection service. CPT indicates these services typically require direct supervision for any or all purposes of patient assessment, provision of consent, safety oversight, and intra-service supervision of staff. When a diagnostic and therapeutic Injection procedure is performed in a POS other than 19, 21, 22, 23, 24, 26, 51, 52, and 61 and an E/M service is  provided on the same date of service, by the Same Individual Physician or Other Health Care Professional only the appropriate therapeutic and diagnostic Injection(s) will be reimbursed and the EM service is not separately reimbursed.

If a significant, separately identifiable EM service is performed unrelated to the physician work (Injection preparation and disposal, patient assessment, provision of consent, safety oversight, supervision of staff, etc.) required for the Injection service, modifier 25 may be reported for the E/M service in addition to 96372-96379. If the E/M service does not meet the requirement for a significant separately identifiable service, then modifier 25 would not be reported and a separate E/M service would not be reimbursed.

Do and Don’t with IM injection 96372 CPT code

For administration of vaccines/toxoids, report CPT code  90460, 90461, 90471, 90472

Use CPT code  96372 for non-antineoplastic hormonal therapy injections

Report CPT code  96401 for anti-neoplastic nonhormonal injection therapy

Report CPT code 96402 for anti-neoplastic hormonal injection therapy

Do not report CPT 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 96372 when the physician or other qualified health care professional is not present

CPT code 96372 does not include injections for allergen immunotherapy. For allergen immunotherapy injections, use CPT code 95115-95117

When codes 96360-96549 are reported by the FACILITY, the following instructions apply. The initial code should be selected using a hierarchy whereby chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services which are primary to hydration services. Infusions are primary to pushes, which are primary to injections. This hierarchy is to be followed by FACILITIES and supersedes parenthetical instructions for add-on codes that suggest an add-on code of a higher hierarchical position may be reported in conjunction with a base code of a lower position.

Related 96372 CPT codes

96373 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intra-arterial

96374 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug

+96375 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure)

+96376 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure)

96377 Application of on-body injector (includes cannula insertion) for timed subcutaneous injection

96379 Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion

Medically Unlikely Edits (MUEs)

“An MUE for a HCPCS/CPT code is the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.”

Before going ahead we will first learn about the MUE Adjudication Indicator (MAI). Below you will get the information about them.

The MAI provides the rationale for the edit.

• MAI 1: Claim Line Edit. 
  • You may add a modifier to bill the same code on separate lines of a claim to identify additional medically necessary units over the MUE value.
• MAI 2: Absolute Date of Service Edit. 
  • These are “per day” edits based on policy. CGS will not pay in excess of the MUE value.
• MAI 3: Date of Service Edit. 
  • These are “per day” edits based on clinical benchmarks. CGS may pay over the MUE value at the appeals (Redetermination) level if there is adequate documentation of medical necessity to support additional units.

Below are the MUE for CPT code 96372

The MUE for 96372 is 4
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: Clinical: Data

MUE for CPT code 96374

The MUE for 96374 is 1
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: Code Descriptor / CPT Instruction

MUE for CPT code +96375

The MUE for 96375 is 6
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: Clinical: Data

MUE for CPT code +96376

The MUE for 96376 is 0
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: CMS Policy

MUE for CPT code 96377

The MUE for 96377 is 1
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: Nature of Service/Procedure

MUE for CPT code 96379

The MUE for 96379 is 1
The MAI is 3 Date of Service Edit: Clinical
MUE Rationale: Clinical: Data

NCCI edits for CPT code 96372

source: https://www.cgsmedicare.com/medicare_dynamic/j15/mue/mue_tool.aspx