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The CPT® Code 96370 refers to the process of administering a subcutaneous infusion for therapeutic or prophylactic purposes, specifically for each additional hour beyond the initial hour of infusion. This code is utilized in conjunction with the primary procedure code, which is CPT® Code 96369, that covers the first hour of subcutaneous infusion. The procedure involves the careful setup of an infusion pump and the establishment of one or more infusion sites on the patient's body. Aseptic technique is crucial throughout the process to prevent infection, and it includes the use of sterile syringes and needles to withdraw the prescribed medication. The infusion sites are typically located in areas such as the abdomen, upper buttocks, lateral thigh or hip, and upper arm, and are prepped with antiseptic solutions to ensure cleanliness. Each site is tested to confirm proper placement in the subcutaneous tissue, and once verified, the needles are secured in place. The infusion of the medication is then initiated. CPT® Code 96370 is specifically designated for billing each additional hour of this infusion process, highlighting its role in ongoing treatment or prevention beyond the initial hour of therapy.
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The procedure associated with CPT® Code 96370 is indicated for patients requiring ongoing therapeutic or prophylactic treatment through subcutaneous infusion. This may include, but is not limited to, the following conditions:
The procedure for CPT® Code 96370 involves several critical steps to ensure the safe and effective administration of the subcutaneous infusion. Each step is essential for the successful delivery of the therapy.
After the completion of the subcutaneous infusion, the patient may be monitored for any immediate reactions to the medication. It is essential to assess the infusion sites for signs of infection, irritation, or other complications. Patients may receive instructions on how to care for the infusion sites and what symptoms to watch for that may require medical attention. If the infusion is to continue beyond the initial hour, CPT® Code 96370 should be used for each additional hour of therapy. Documentation of the procedure, including the medication administered, the duration of the infusion, and any observations made during the process, is critical for accurate billing and compliance.
| Short Descr | SC THER INFUSION ADDL HR | Medium Descr | SUBCUTANEOUS INFUSION EACH ADDITIONAL HOUR | Long Descr | Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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 | 3 | CCS Clinical Classification | 231 - Other therapeutic procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96369 | MPFS Status: Active Code APC S 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) |
| 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | JZ | Zero drug amount discarded/not administered to any patient | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Added | - |
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