Initial Drug Administration

According to the CMS Internet Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 230.2 (B),".. only one initial drug administration service is to be reported per vascular access site per encounter, including during an encounter where observation services span more than 1 calendar day."

Two or More Vials

If a drug requires two or more different vials to be safely administered (during the same session or day), then only one initial administration code (i.e., Current Procedural Terminology [CPT®] code 96372) may be billed, regardless if two or more syringes are being used for the same drug.

Separate IV Sites

If two separate intravenous (IV) sites must be used, then two initial administration codes may be billed. The medical records should support the need for the two separate IV sites.

Subsequent/Concurrent

CMS Change Request (CR) 3631 states, "If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent or concurrent code from the appropriate section should be reported. The initial code is the code that best describes the primary service the patient is receiving and the additional codes are secondary to the primary procedure."

See Noridian's Chemotherapy Administration Billing and Hydration webpages for related information.

Last Updated Mon, 12 Oct 2020 16:46:05 +0000