CPT 96366: Additional Hour Intravenous Infusion
Medicare pays $22 and commercial payers pay $54 on average nationally for this procedure.
CPT code 96366 describes the administration of an intravenous infusion for an additional hour or subsequent hours beyond the initial infusion to prevent, treat, or diagnose a condition; this represents an additional-hour IV infusion service (therapy/prophylaxis/diagnosis) typically provided in outpatient infusion centers, hospital outpatient departments, or clinic settings, and the service type is intravenous infusion therapy — additional sequential hours.
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
Medicare’s mean rate of $22.2 for CPT 96366 sits well below BUCA’s average commercial mean of $54.3, indicating a substantial gap between public and commercial reimbursement for this infusion administration code. The $32.1 difference highlights that commercial payers on average reimburse roughly 2.4x Medicare for this service, with Medicare’s central tendency clustered tightly around the low $20s (25th–75th percentiles $21–$23).
Dispersion across payers varies: calculate P75−P25 ranges to compare spread. Aetna’s range is $32.8 ($52.9−$21.1), Blue Cross Blue Shield’s is $34.6 ($80.3−$48.4), BUCA’s is $27.8 ($65.7−$37.9), Cigna’s is $18.7 ($43.2−$21.5), and UnitedHealth Group’s is $20.7 ($42.9−$22.2). Cigna and UnitedHealth Group show the tightest interquartile spreads, while Blue Cross Blue Shield and Aetna show the widest variability.