How do you code chemo administration?
Background: Chemotherapy administration services (CPT codes 96400, 96408 to 96425, 96520 and 96530) , therapeutic or diagnostic infusions (excluding chemotherapy) (CPT codes 90780 to 90781), and drug injection codes (90782 to 90788) are paid under the Medicare physician fee schedule.
How do you bill chemo infusion?
Assign CPT 96360- IV hydration, initial 31-90 minutes, and CPT 96361 (add on code), used once infusion lasts 91 minutes in length. An intravenous infusion of hydration of 30 minutes or less is not billable. Hydration infusion must be at least 31 minutes in length to bill the service.
How is chemo billed insurance?
If you’re a hospital outpatient, you’ll be charged a Part B copay. And if you get your chemo in a doctor’s office or clinic, you’ll pay 20 percent of the Medicare-approved amount as well as toward the Part B deductible, if applicable.
When do you use CPT 96372?
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.
Can you bill for chemo teaching?
If there is sufficient documentation of a separately-identifiable E&M visit on the same day as the chemo administration, you can bill both. However, there is an element of patient education prior to chemo administration that is bundled into the code(s).
How do you bill for infusion services?
Intravenous (IV) infusions are billed based upon the CPT®/HCPCS description of the service rendered. A provider may bill for the total time of the infusion using the appropriate add-on codes (i.e. the CPT®/HCPCS for each additional unit of time) if the times are documented.
Does CPT 96365 need a modifier?
For example, CPT code 96365 is used for coding the primary or initial code as per hierarchy and suppose if there are two or more IV site for infusion, then you can go ahead and used the same code with 59 or X-{EUPS}modifier (96365, 96359-XU).
Does CPT 96374 need a modifier?
In that case, you would bill CPT code 96374, “Intravenous push, single or initial substance/drug” with modifier -59 because the incident is separate from the first visit and another IV placement had to be performed. Time is a factor in all hydration and infusion codes.
Is chemotherapy covered by Medicare Part B?
Part B pays for some oral chemotherapy medications. It may also cover IV chemotherapy that a person receives in a doctor’s office or freestanding clinic. Copayment and coinsurance costs may apply.
Can you Bill 2 units 96372?
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).
Can you bill 96372 without an office visit?
You may report 96372 in the facility without the physician present. Injections for allergen immunotherapy have their own administration codes, 95115-95117.