Summary & Overview
CPT 96373: Intra-Arterial Medication Administration
CPT code 96373 is a procedural billing code used for the intra-arterial administration of medications or substances, a technique employed to treat, prevent, or diagnose various medical conditions. This service is typically performed in an office setting and falls under the category of Nursing Services and Procedures. The code is relevant for a range of clinical scenarios where arterial access is necessary, such as managing chronic diseases or delivering targeted therapies.
Major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare recognize and reimburse for this code, making it a significant component of outpatient procedural billing. The publication provides an overview of payer coverage, clinical context, and related coding practices. Readers will gain insight into the procedural details, typical clinical indications, and how this code fits within broader office-based care. The summary also highlights associated modifiers and taxonomies, as well as common ICD-10 diagnoses linked to the procedure, offering a comprehensive view of its use in practice.
Key benchmarks, policy updates, and clinical context are discussed to inform stakeholders about the national landscape for CPT code 96373. The article is designed to support understanding of procedural coding, payer coverage, and clinical relevance for intra-arterial medication administration.
CPT Code Overview
CPT code 96373 describes the administration of a medication or other substance directly into an artery. This procedure is performed to treat, prevent, or diagnose a medical condition and is classified under Nursing Services and Procedures. The typical site of service for this code is the office setting (Place of Service 11). This code is commonly used in clinical scenarios where arterial access is required for effective delivery of therapeutic or diagnostic agents.
Clinical & Coding Specifications
Clinical Context
A patient with a chronic condition such as essential hypertension, type 2 diabetes mellitus, or chronic obstructive pulmonary disease presents to the office for ongoing management. During the visit, the provider determines that an intra-arterial injection of a medication or diagnostic substance is necessary to treat, prevent, or evaluate the patient's condition. The procedure is performed by a registered nurse or physician in the office setting (Place of Service 11), following standard protocols for arterial access and medication administration. The workflow includes patient assessment, preparation for arterial injection, administration of the substance, and post-procedure monitoring.
Coding Specifications
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Modifier
59: Distinct Procedural Service. Used when the intra-arterial injection (96373) is performed separately from other procedures, indicating it is not part of a bundled service. -
Modifier
51: Multiple Procedures. Applied when more than one procedure is performed during the same session, such as when96373is provided alongside other injections or services.
| Modifier Code | Description |
|---|---|
59 | Distinct Procedural Service |
51 | Multiple Procedures |
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Provider Taxonomies:
163W00000X— Registered Nurse207Q00000X— Family Medicine Physician207R00000X— Internal Medicine Physician
These taxonomies represent the specialties authorized to perform and report the intra-arterial injection procedure in an office setting.
Related Diagnoses
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Z79.899: Other long term (current) drug therapy- Indicates the patient is receiving ongoing medication therapy, which may necessitate intra-arterial administration for certain drugs.
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I10: Essential (primary) hypertension- Represents chronic high blood pressure, a condition that may require intra-arterial medication for management or diagnostic purposes.
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E11.9: Type 2 diabetes mellitus without complications- Used for patients with diabetes who may need intra-arterial injections for diagnostic or therapeutic reasons.
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J44.9: Chronic obstructive pulmonary disease, unspecified- Applies to patients with COPD, who may require intra-arterial medication administration as part of their treatment plan.
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M54.5: Low back pain- Relevant for patients experiencing low back pain, potentially requiring intra-arterial injections for pain management or diagnostic evaluation.
Related CPT Codes
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96372: Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular- Used for injections administered via subcutaneous or intramuscular routes. May be performed in the same session as
96373if multiple medications or substances are required.
- Used for injections administered via subcutaneous or intramuscular routes. May be performed in the same session as
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96374: Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug- Used for intravenous push injections. Can be an alternative to
96373if the medication is administered intravenously rather than intra-arterially.
- Used for intravenous push injections. Can be an alternative to
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99213: Established patient office or other outpatient visit, typically 15 minutes- Commonly reported for the evaluation and management of established patients. May be used in conjunction with
96373when the injection is part of a broader office visit.
- Commonly reported for the evaluation and management of established patients. May be used in conjunction with
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99214: Established patient office or other outpatient visit, typically 25 minutes- Used for more complex office visits. Often paired with
96373when the patient's condition requires additional evaluation and management.
- Used for more complex office visits. Often paired with
These codes are related to 96373 either as alternative routes of administration, or as evaluation and management services that may occur during the same encounter.