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A subcutaneous infusion for therapy or prophylaxis is a medical procedure coded as CPT® 96369, which involves the administration of a specified substance or drug through the subcutaneous tissue for an initial duration of up to one hour. This procedure includes essential components such as the setup of the infusion pump and the establishment of the infusion site(s). During the procedure, healthcare professionals utilize aseptic techniques to ensure safety and minimize the risk of infection. A sterile syringe and needle are employed to withdraw the prescribed medication, which is then transferred into the pump reservoir. The preparation of the pump and tubing is crucial for the successful delivery of the medication. The selection of infusion sites is based on the total dosage required and may include common areas such as the abdomen, upper buttocks, lateral thigh or hip, and upper arm. Each selected site is prepped with an antiseptic solution to maintain sterility. A needle is inserted into the subcutaneous tissue at each site, and verification is performed to ensure proper placement by checking for blood flow. Once confirmed, the needles are secured with tape, and the medication is administered. For any additional hours of infusion beyond the initial hour, CPT® 96370 should be used, while CPT® 96371 is applicable for each additional pump setup with new infusion sites.
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The procedure coded as CPT® 96369 is indicated for the administration of therapeutic or prophylactic substances or drugs via subcutaneous infusion. This method is typically employed in situations where continuous medication delivery is necessary for patient management. Specific indications may include:
The procedure for CPT® 96369 involves several critical steps to ensure the safe and effective administration of the medication. These steps include:
After the completion of the subcutaneous infusion procedure, the patient is monitored for any immediate reactions to the medication. It is important to ensure that the infusion sites remain clean and dry, and the patient should be advised on how to care for these sites. Any signs of infection or adverse reactions should be reported to the healthcare provider promptly. If the infusion is to continue beyond the initial hour, the appropriate CPT® code 96370 should be utilized for each additional hour of therapy. Additionally, if a new pump setup is required, CPT® 96371 should be used for each subsequent setup with new infusion sites.
| Short Descr | SC THER INFUSION UP TO 1 HR | Medium Descr | SUBCUTANEOUS INFUSION INITIAL 1 HR W/PUMP SET-UP | Long Descr | Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 231 - Other therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 96370 | Addon Code MPFS Status: Active Code APC S Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | 96371 | Addon Code MPFS Status: Active Code APC Q1 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | JZ | Zero drug amount discarded/not administered to any patient | LT | Left side (used to identify procedures performed on the left side of the body) | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
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