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The CPT® Code 96521 refers to the process of refilling and maintaining a portable pump that is utilized for the prolonged infusion of various therapeutic agents, including chemotherapy drugs, monoclonal antibodies, biologic response modifiers, and other antineoplastic substances. Prolonged infusion is specifically characterized as the administration of these substances over a duration exceeding eight hours. The portable pump is filled with a predetermined quantity of the medication, which is often complex in nature, and is programmed to deliver this medication continuously throughout the specified infusion period. It is essential to regularly check the functionality of the pump to ensure that it is operating correctly and that the medication is being dispensed as intended. For external portable pumps, the appropriate code to use is 96521, while 96522 should be used for implantable pumps or reservoirs.
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The procedure associated with CPT® Code 96521 is indicated for patients requiring prolonged infusion of specific therapeutic agents. The following conditions or situations may warrant the use of this procedure:
The procedure for refilling and maintaining a portable pump involves several critical steps to ensure the safe and effective delivery of medication. Each step is essential for the proper functioning of the pump and the successful administration of the therapeutic agent.
After the procedure, the patient may be monitored for any immediate reactions to the medication. It is important to provide the patient with instructions regarding the care and maintenance of the portable pump, including how to recognize signs of malfunction or complications. Patients should be advised to report any issues, such as pain, swelling, or unusual symptoms, to their healthcare provider promptly. Regular follow-up appointments may be necessary to assess the effectiveness of the treatment and to perform additional refills as required.
| Short Descr | REFILL/MAINT PORTABLE PUMP | Medium Descr | REFILLING & MAINTENANCE PORTABLE PUMP | Long Descr | Refilling and maintenance of portable pump | 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 | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 2 | CCS Clinical Classification | 237 - Ancillary Services |
| 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | GA | Waiver of liability statement issued as required by payer policy, individual case | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 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 | 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. | 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 | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | JZ | Zero drug amount discarded/not administered to any patient | KD | Drug or biological infused through dme | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q5 | Service furnished under a reciprocal billing 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) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2011-01-01 | Changed | Short description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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