Current Procedural Terminology (CPT) codes serve as the standardized language used by healthcare providers and payers to describe medical procedures and services. These five-digit codes are necessary for tracking service frequency, ensuring compliance, and processing claims for proper reimbursement. CPT Code 96374 is one of the most frequently used administration codes, specifying a particular type of drug delivery. Understanding the precise application of this code is fundamental for accurate billing and avoiding claim denials. This code is often confused with other injection codes, making its correct interpretation a common challenge for providers.
The Specific Service Covered by 96374
CPT Code 96374 is officially described as “Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug.” This code captures the professional work involved in administering medication directly into a vein over a short period. An “IV push” refers to the rapid, direct injection of a drug, typically lasting 15 minutes or less, without a prolonged drip infusion.
The service covers the initial preparation, the actual administration, and the immediate patient monitoring performed by the clinician. It is used for therapeutic purposes (treating a condition), prophylactic purposes (preventing a complication), or for diagnostic agents. Importantly, 96374 only reports the administrative act and does not cover the cost of the drug itself, which must be billed separately using the appropriate HCPCS Level II code.
Documentation Requirements for Proper Use
Accurate medical documentation is the primary defense against claim denials related to CPT Code 96374. Payers require detailed records to establish the medical necessity of the service provided. The clinical chart must clearly specify the exact name and dosage of the medication administered.
Mandatory documentation also includes the route of administration, which must be explicitly stated as an intravenous push. Precise start and stop times for the IV push are essential, as time documentation helps distinguish this service from other infusion codes. Finally, the documentation must support the clinical purpose (therapeutic, prophylactic, or diagnostic) to justify the service.
Distinguishing 96374 from Other Injection Codes
The distinction between drug administration codes rests primarily on the route of delivery and the duration of the service. CPT Code 96374 is strictly for an intravenous push. This differentiates it from CPT Code 96372, which is used for injections delivered subcutaneously or intramuscularly.
The IV push (96374) is also distinct from the codes used for IV infusions, such as the CPT 96365 series. Infusions involve a continuous drip of a substance and typically require a delivery time exceeding 15 minutes to be separately reportable. Furthermore, 96374 is not used for hydration services, which are coded in the CPT 96360 series and require a minimum administration time of 31 minutes. The rapid, direct nature of the IV push is the defining factor separating 96374 from longer infusion or non-intravenous services.
Rules for Billing Multiple Injections and Services
When multiple drugs are administered via IV push during a single patient encounter, only the initial substance is reported with CPT Code 96374. If a different substance is administered sequentially, the additional service is reported using the add-on code CPT 96375. Therefore, 96374 is billed only once per encounter, regardless of the number of substances pushed.
If the injection is performed during the same visit as a separate evaluation and management (E/M) service, a modifier is required. Modifier -25 is appended to the E/M code to indicate that the IV push was a separately identifiable service performed on the same day. This alerts the payer that the injection was not bundled with the E/M visit.