CPT Code 96372 Description & Reimbursement Guidelines

If you want to file for reimbursement of your services, every minute detail will make a huge difference. According to a Medical Group Management Association (MGMA) survey, approximately 20% of all claims based on industry norms are denied.

This figure highlights the importance of understanding CPT code 96372 to ensure the reimbursement of drug administration. Otherwise, the incorrect use of 96372 may result in delays or claim denials, eventually hurting your practice’s financial health. 

The proper usage of CPT code 96372 is thoroughly covered in this article, which also reveals the billing rules that can save you from claim denials. 

CPT Code 96372 Description

CPT code 96372 refers to administering therapeutic, diagnostic, or prophylactic drugs via intramuscular (through the muscle) or subcutaneous (through the skin) injections. However, you can not use these injections as part of very sophisticated pharmacological regimens or chemotherapy. The American Medical Association (AMA) has other CPT codes for injecting vaccinations, toxoids, and chemotherapy medications into patients’ bodies. 

You can bill CPT code 96372 for the following services:

• If you administer vitamins or antibiotics via injection
• Giving steroids or medications for pain management
• Administering allergy shots for desensitization

Furthermore, you will utilize this code when the injection is the main service and not a component of a more extensive treatment.

Appropriate Use Cases for CPT Code 96372

Let’s look at the clinical applications of CPT 96372. 

Injecting Antibiotics for Pneumonia

Pneumonia treatment is the most common example of CPT code 96372. Suppose an elderly patient comes to your practice and you cannot put him on antibiotics for any reason. You decide to treat his condition through an intramuscular antibiotic shot. 

Injecting a Pain Management Shot

Suppose a woman in her mid-30s suffers from excruciating pain in her back. After taking several medicines and treatments, the pain persisted. She visited a pain management clinic, and the physician suggested a shot of spinal epidural injections that would help her reduce her back pain. In this case, you will use the CPT code 96372. 

Injection for Reducing Drug Addiction

In the last scenario, suppose a man above 30 walks into the clinic with an opioid addiction. Upon checkup, the physician discovered severe, dangerous symptoms of overdose, which may lead to his death. The physician administered an intramuscular injection of naltrexone (Vivitrol) to treat opioid addiction, prevent the euphoric effects of drugs, and promote recovery. In this case, he will bill this service with CPT code 96372.

Modifiers to Append with CPT Code 96372

The following modifiers can be appended to CPT 96372 to provide supplemental information and increase the chances of fair reimbursement. 

Modifier 59

Modifier 59 denotes distinct procedures or services rendered on the same day. It is appended when the two services are normally bundled under one payment. However, note that you should not overuse/misuse this modifier, and your documentation must support the appropriate circumstances for its usage.

Modifier 76

Modifier 76 explains that the same physician repeated a procedure or service on the same day. In simpler words, if you are a service provider (physician), you perform the same service again on the same day or during the postoperative period, you will append this modifier to CPT code 96372. 

Modifier 77

The only difference between modifiers 76 and 77 is that this modifier denotes a procedure repeated on the same patient on the same day by a different provider. 

Reimbursement Guidelines for CPT Code 96372

Here are the crucial billing tips and reimbursement guidelines for CPT 96372. 

Report One Unit per Shot

You must bill a single unit under CPT code 96372, even if the same medication is in two different shots or injected one after another. This is because Medicare only pays for single drug administration. However, if you have performed a separate procedure of administering separate drugs with different codes, you must report under the CPT code 96372 with a modifier 59.

Include Supporting Documents

Your reimbursement depends on accurate coding and documentation. Practices must accurately document the patient’s medical history and treatment plan, along with any pertinent diagnoses or conditions to prove the procedure’s medical necessity. Furthermore, if you are appending any modifiers (particularly modifier 59), it is vital to submit the claim with supporting documents.

Follow the Rules and Regulations

The injection must be administered by a licensed physician or under the close supervision of one if administered by his assistant or a registered nurse. This guarantees that the process is carried out securely as per all relevant rules and regulations.

Final Thoughts on CPT Code 96372

CPT code 96372 may appear straightforward. However, many providers continue to have their claims denied when they bill for such simple services. The reasons behind those denials are incorrect use of the CPT code, application of wrong modifiers, or failure to fulfill the Medicare requirements. 

Therefore, your practice can outsource to professional medical billing and coding services to avoid these complexities. These billing companies keep up with the most recent regulations and payer guidelines while handling the entire billing process, relieving you of the stress of compliance and invoicing.

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