CPT 96367: Additional IV Infusion of Different Medication, Up to 1 Hour
Headline: CPT code 96367: Added IV Infusion of a Different Medication for Up to One Hour
Lead: CPT code 96367 covers an additional intravenous infusion, following an initial infusion, using a different medication or substance for up to one hour. The code captures sequential IV therapy delivered to prevent, diagnose, or treat medical conditions and is relevant to infusion clinics, outpatient departments, and hospitals nationwide.
What the code represents and why it matters: CPT code 96367 identifies time-limited, sequential intravenous infusions of a distinct medication after an initial infusion. It matters nationally because accurate coding affects clinical workflow documentation, billing clarity for complex infusion encounters, and consistency across payers for services that often occur in outpatient infusion centers and hospital infusion units.
Key payers covered: This analysis includes nationwide private and public payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Overview of reader takeaways: Readers will gain concise benchmarks for how the code is used in practice, comparisons across major payers, clinical contexts where sequential infusions are applied, and operational considerations for documenting an additional infusion episode. Related infusion coding and concurrent or additional-hour codes are noted for coding continuity. Data not provided in the input will be identified as such.
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Billing Code Overview
CPT code 96367 describes the administration of an additional intravenous infusion or infusions after an initial infusion, using a different medication or substance, for a period of up to one hour. The service is intended to prevent, treat, or diagnose a condition or disease and is reported in addition to the primary infusion service.
Service type: Additional intravenous infusion of a different medication or substance (up to one hour)
Typical site of service: Infusion therapy clinic/center or hospital outpatient infusion area, where sequential IV infusions are delivered and monitored.
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When the additional infusion is a distinct service separate from the primary infusion and documentation supports separate clinical purpose and administration. |
76 | Repeat procedure or service by same physician | When the same clinician performs a repeated additional infusion service later the same day. |
77 | Data not provided in input | Data not available in the input. |
52 | Reduced services | When the additional infusion was started but not completed as documented (partial service). |
53 | Discontinued procedure | When the additional infusion was initiated but discontinued due to patient instability or adverse reaction. |
59 | Distinct procedural service (duplicate entry prevented) | Data not applicable twice; only include once in billing. |
91 | Repeat clinical diagnostic laboratory test | When therapeutic drug level monitoring specimens are repeated related to the infusion; appended to lab procedure, not typically to infusion code. |
25 | Significant, separately identifiable evaluation and management service | When an E/M visit is performed on the same day for a separate reason and properly documented. |
59 | See above | Duplicate entries avoided in claims; use once. |
XU | Unusual non-overlapping service | When documentation supports that the additional infusion is distinct and non-overlapping with other services (select when payer recognizes X modifiers). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
261QI0500X | Infusion Therapy Clinic/Center | Typical site of service for outpatient IV infusions and additional sequential infusions. |
207RI0011X | Interventional Cardiology Physician | May be involved when infusions relate to cardiac procedural therapies; less common for this code but listed taxonomy. |
207R00000X | Internal Medicine Physician | Common ordering and supervising specialty for outpatient infusion therapies and medication management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z51.81 | Encounter for therapeutic drug level monitoring | Supports visits where drug levels guide additional IV dosing or monitoring related to sequential infusions. |
T80.89XA | Other complications following infusion, transfusion and therapeutic injection, initial encounter | Applicable when the additional infusion addresses or follows a documented infusion-related complication. |
Z79.899 | Other long term (current) drug therapy | Indicates ongoing long-term IV medication therapy requiring repeated or additional infusions. |
R50.9 | Fever, unspecified | Clinical indication for administering an additional IV antipyretic or antibiotic following an infusion-related febrile response. |
R11.2 | Nausea with vomiting, unspecified | Clinical indication for administering an additional IV antiemetic following or after a primary infusion that caused nausea. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96366 | Intravenous 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. |
96368 | Intravenous 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. |