Can 96372 and 96401 be billed together?

Can 96372 and 96401 be billed together?

Most carriers, including Medicare, require the use of CPT 96372 for the administration of Xolair, but may allow multiple units of the code. Some insurance carriers will accept the billing of CPT 96401, but will only allow one unit to be billed.

Does CPT code 96401 need a modifier?

New patient CPT codes require CPT modifier 25 when a separately identifiable E/M service is performed the same day as chemotherapy or nonchemotherapy infusions or injections as these are not considered surgery. For example, CPT codes 96401 and 96372.

What is the difference between 96401 and 96372?

96401 is for chemotherapy injections. Humira, Dupixent and Stelara are not chemotherapy, so you have to use 96372.

Can you bill 96372 with 2 units?

The IM or SQ injection can be billed more than once or twice. If the drug is prepared and drawn up into two separate syringes and it is then administered in two individual injections in two distinct anatomic sites, you can bill two units of code 96372 (billing second unit with modifier 76).

Is 96372 payable by Medicare?

A: Medicare requires the use of CPT code 96372 –Therapeutic, prophylactic, or diagnostic injection, specify substance or drug; subcutaneous or intramuscular for the administration of biologics.

Does 96372 need a modifier?

When a patient receives two or three intramuscular or subcutaneous injections, CPT code 96372 should be reported for each injection performed (either IM or SubQ). Modifier 59, Distinct Procedural Service, would be appended to the second and any subsequent injection codes listed on the claim form.

How do I bill CPT 96413?

96413—Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug….

1. 96413 x 1 for the first hour of oxaliplatin.
2. +96415 x 1 for additional hour of oxaliplatin.
3. +96411 for the IV push of 5-FU, and.
4. 96416 x1 for the initiation of 5-FU on the pump.

96401 is for chemotherapy injections. Humira, Dupixent and Stelara are not chemotherapy, so you have to use 96372. Thank you. I’ll talk to provider again.

What kind of drugs is CPT 96401 used for?

CPT 96401 is used for chemotherapy and other highly complex drugs and biologic agents. Not all payers will accept 96401, like Medicare so you have to be aware of that.

What is the code for a Prolia injection?

96372 is the code we use when a patient comes in for their Prolia injection.

Can You bill for Dupixent with CPT 96401?

I’ll talk to provider again. You actually can bill 96401 for Dupixent because it is a biological agent. CPT 96401 is used for chemotherapy and other highly complex drugs and biologic agents. Not all payers will accept 96401, like Medicare so you have to be aware of that.