CPT 96365: Initial Intravenous Infusion, Up to 1 Hour
Medicare pays $70 and commercial payers pay $220 on average nationally for this procedure.
CPT code 96365 describes the initial intravenous infusion of a medication or other substance administered by a provider for a period up to one hour for prevention, treatment, or diagnosis; this service is an infusion therapy encounter typically delivered in an infusion clinic/center, hospital outpatient department, or emergency department and is billed as the initial short-duration IV infusion service.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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National Reimbursement Benchmarks
National means show a clear split between Medicare and commercial benchmarks: Medicare’s mean is $70, while BUCA’s mean (as a proxy for average commercial) is $219.70, more than three times higher than Medicare. This gap highlights the premium commercial payers place on CPT 96365 relative to Medicare reimbursement.
Dispersion measured by the interquartile range (P75–P25) varies notably across payers. Blue Cross Blue Shield has the widest IQR at $129.90 ($354.30–$230.40), indicating substantial regional or contract variability, while Aetna is the tightest with an IQR of $67.50 ($139.40–$67.50). UnitedHealth Group and Cigna show moderate dispersion at $63.90 and $68.00 respectively, and BUCA’s IQR is $100.70 ($262.00–$161.30). Medicare’s IQR is narrow at $9 ($73–$64).