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    OpenPayerBilling CodesTherapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration)CPT cpt-96367-additional-intravenous-infusion-different-substance-up-to-1-hour
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    CPT 96367: Additional IV Infusion of Different Medication, Up to 1 Hour

    Medicare pays $31 and commercial payers pay $78 on average nationally for this procedure.

    CPT code 96367 describes administration of an additional intravenous infusion of a different medication or substance, given after an initial infusion, for up to one hour to prevent, treat, or diagnose a condition; this represents an additional IV infusion service typically performed in an outpatient infusion clinic or hospital infusion suite and is billed as a separate infusion service following the primary infusion.

    For related coverage guidance, see recent payer policy updates: Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disorders, Esophagogastroduodenoscopy (EGD) Coverage Policy, Radiofrequency Therapy for Fecal Incontinence.

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    National Reimbursement Benchmarks

    Medicare's mean rate of $31 sits well below BUCA's average commercial mean of $77.5, indicating a substantial gap between federal reimbursement and that commercial benchmark. The median for Medicare is $30 (P25 $29, P75 $32), reflecting a tightly clustered Medicare locality distribution around its mean, while BUCA's P25 $52.1 and P75 $95.4 suggest higher commercial variability and overall pricing.

    Comparing interquartile spreads (P75–P25) highlights dispersion differences: Blue Cross Blue Shield shows a spread of $52.1, Aetna $36.9, Cigna $32.2, UnitedHealth Group $28.7, and BUCA $43.3; Medicare's spread is $3. Note that Blue Cross Blue Shield and BUCA are among the widest, indicating broader commercial rate variability, whereas Medicare is the tightest by a large margin.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 62-year-old patient with a history of metastatic colorectal cancer presents to an infusion therapy clinic for ongoing outpatient intravenous treatments. Earlier in the visit the patient received a primary chemotherapy infusion (e.g., 90 minutes of a primary agent) and, after completion, the oncology clinician determines an additional different IV medication is required for symptom control and prophylaxis (for example, a one-hour intravenous antiemetic or an antihypersensitivity agent to treat infusion-related fever and nausea). The clinician documents the medically necessary new medication, starts an additional IV line or uses the existing IV access when clinically appropriate, and administers the subsequent distinct medication as a separate infusion lasting up to one hour. Nursing documents start and stop times, the specific drug name and dose, patient response (for example, reduction in fever or nausea), and any complications. The encounter may be billed in the outpatient infusion center setting under the infusion therapy clinic taxonomy, with diagnosis codes supporting therapeutic drug monitoring, complications after infusion, ongoing drug therapy, or symptoms such as fever and nausea as clinically applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96366Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour (List separately in addition to code for primary procedure)Used when an infusion continues beyond the initial hour; billed in addition to the primary infusion code for additional time increments.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    91Modifier 91 — “Repeat Clinical Diagnostic Laboratory Test” — is appended when the exact same CPT laboratory test is performed more than once for the same patient on the same day because serial,…- Use modifier 91 when the exact same CPT laboratory test is performed more than once on the same patient on the same date because serial or repeated testing is medically necessary to monitor…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    261QI0500X
    207RI0011X
    207R00000X
    207W00000X
    156FX1700X
    163WX0002X
    261QM0850X
    225C00000X

    Related ICD-10-CM Codes

    31 rows

    ICD-10-CM CodeDescription
    C18.9Malignant neoplasm of colon, unspecified
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.911Malignant neoplasm of unspecified site of right female breast
    D64.9Anemia, unspecified
    D69.6Thrombocytopenia, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    E86.0Dehydration
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    G89.3Neoplasm related pain (acute) (chronic)

    Showing 1–10 of 31

    Related Payer Policy Updates

    Specialty: Gastroenterology1 / 3

    10 rows

    PolicyPayerEffective Date
    Percutaneous Electrical Nerve Field Stimulation for Functional Abdominal Pain Disordersbcbsvermont2026-12-01
    Esophagogastroduodenoscopy (EGD) Coverage Policyevicore2026-11-05
    Radiofrequency Therapy for Fecal IncontinenceCigna2026-10-15
    Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD)univerahealthcare2026-10-15
    High-Resolution Anoscopy (HRA)Premera Bluecross2026-10-01
    Gastroesophageal and Gastrointestinal (GI) Services and ProceduresColorado Rocky Mountain Health Plans2026-10-01
    Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver DiseaseOscar Health2026-10-01
    Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant TestingOscar Health2026-10-01
    Pancreatic Enzyme Testing for Acute PancreatitisOscar Health2026-10-01
    Helicobacter pylori TestingOscar Health2026-10-01

    Related Codes

    CPT-96365-INITIAL-INTRAVENOUS-INFUSION-UP-TO-1-HOUR

    CPT 96365: Initial Intravenous Infusion, Up to 1 Hour

    CPT-96366-ADDITIONAL-HOUR-INTRAVENOUS-INFUSION

    CPT 96366: Additional Hour Intravenous Infusion

    CPT-96368-CONCURRENT-INTRAVENOUS-INFUSION-MULTIPLE-MEDICATIONS

    CPT 96368: Concurrent Intravenous Infusion of Multiple Medications

    CPT-96369-SUBCUTANEOUS-INFUSION-SETUP-AND-ADMINISTRATION-UP-TO-1-HOUR

    CPT 96369: Infusion Pump Setup with Subcutaneous Port, Up to 1 Hour

    CPT-96370-SUBCUTANEOUS-INFUSION-ADDITIONAL-HOUR

    CPT 96370: Subcutaneous Infusion Per Additional Hour

    CPT-96371-SUBCUTANEOUS-PORT-SITE-ESTABLISHMENT-AND-INFUSION-PUMP-SETUP

    CPT 96371: Subcutaneous Port Relocation with Infusion Pump Administration

    CPT-96372-SUBCUTANEOUS-INTRAMUSCULAR-INJECTION-THERAPEUTIC-PROPHYLACTIC-DIAGNOSTIC

    CPT 96372: Intramuscular or Subcutaneous Therapeutic Injection

    CPT-96373-ARTERIAL-MEDICATION-ADMINISTRATION

    CPT 96373: Intra-arterial Medication Administration

    CPT-96374-INTRAVENOUS-PUSH-SINGLE-MEDICATION

    CPT 96374: Rapid Intravenous Push Medication Administration

    CPT-96375-SEQUENTIAL-IV-PUSH-NEW-DRUG-ADD-ON

    CPT 96375: IV Push Sequential Drug Infusion (New Drug Add-On)

    Showing 1–10 of 15

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    96368Intravenous infusion, for therapy, prophylaxis, or diagnosis; concurrent infusion (List separately in addition to code for primary procedure)Used when a second infusion of a different or same agent is administered concurrently through separate IV access during the same time period as another infusion.