How to get paid for injection administrations

Getting denied for injection administration can be common. How to make sure you get paid.

Question: At times, we are getting denials for our injection administration.Can you give us guidance as to how to bill these correctly?

Answer: Across the country, in offices and facilities, coders are having trouble with CPT 96372 - Therapeutic, prophylactic, or diagnostic injection, specify substance, or drug; subcutaneous or intramuscular.

The primary intent of an injection as described by 96372 is generally to deliver a small volume of medication in a single shot subcutaneous (sub-Q), intramuscular (IM), or intra-arterial (IA) routes, as opposed to an intravenous (IV) injection/push that requires a commitment of time. 96372 CPT code reimbursement is allowed when the injection is performed alone or in conjunction with other procedures/services as allowed by the National Correct Coding Initiative (NCCI).

Separate reimbursement will not be allowed for CPT code 96372 when billed in conjunction with an Evaluation and Management (E/M) Service (CPT code 99201-99499) by the same rendering provider on the same date of service.

As 96372 is applied incorrectly, providers are not being paid for this injection administration code. Here are some things to keep in mind when billing this code:

  • Codes 96372-96379 are not intended to be reported by the physician in the facility setting.
  • E/M services provided in a non-facility setting are considered an inherent component for providing an injection service. If a significant, separately identifiable E/M service is performed unrelated to injection service, modifier 25 may be reported for the E/M service in addition to 96372-96379.
  • 99211 will not be reimbursed when submitted with 96372, with or without modifier 25. This very low service level code does not meet the requirement for ‘significant’ as defined by CPT, and therefore should not be submitted in addition to the procedure code for the Injection.
  • Preventive medicine codes (99381-99412, 99429) do not need modifier 25 to indicate a separate service when reported in addition to the injection. The preventive medicine codes include routine services such as the ordering of immunizations or diagnostic procedures, so it’s expected that these services will be reported in addition to a preventive medicine code.

Renee Dowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.