Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • NPI Medicare & Medicaid
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesTherapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration)CPT cpt-96369-subcutaneous-infusion-setup-and-administration-up-to-1-hour
    Ask Trek AI about this page

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

    Medicare pays $152 on average nationally for this procedure.

    CPT code 96369 describes setup of an infusion pump, establishment of a subcutaneous port site, and infusion of a medication via the pump for up to one hour; this represents a short-duration therapeutic or prophylactic infusion service typically performed in outpatient infusion centers, physician offices, or ambulatory clinics and involves pump programming and drug administration through a subcutaneous access device.

    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.

    Customize your policy alerts

    Sign up for cpt 96369 policy alerts

    Get alerted when payer policies referencing 96369 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    Table of contents

    Progress1 / 7

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools

    Clinical & Coding Specifications

    Clinical Context

    A 58-year-old patient with metastatic hormone-refractory prostate cancer requires intermittent subcutaneous infusion of a medication (such as a short-duration analgesic or antiemetic) delivered via a portable ambulatory infusion pump. The patient presents to an outpatient oncology infusion clinic where the nurse and provider prepare and program the ambulatory pump, access or establish a subcutaneous port or needle site (e.g., a tunneled subcutaneous infusion catheter or on-body pump site), and initiate a continuous or intermittent infusion that will run for up to one hour. The clinical workflow includes verification of the medication and dose, aseptic site preparation, pump setup and programming, patient education on pump function and site care, monitoring for immediate adverse reactions during the infusion period, and documentation of drug, lot number, start and stop times, and site appearance. Typical sites of service include hospital outpatient infusion centers, freestanding infusion clinics, ambulatory surgery centers when performed as part of a larger procedure, and sometimes home health settings when a clinician sets up the pump during a visit. The procedure is performed for therapeutic or preventive indications where a short-duration subcutaneous infusion is clinically indicated and the provider is responsible for pump setup and supervision during the up-to-one-hour infusion.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96360Intravenous infusion, hydration; initial, 31 minutes to 1 hourPerformed when IV hydration is provided alongside short-duration therapeutic infusions; documents initial infusion time for IV route.
    96361Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary service)Used if infusion time extends beyond one hour and continuation needs separate reporting.
    96365Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hourUsed for IV route when therapy is administered via peripheral or central IV rather than subcutaneous; related when route selection differs.
    96366Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour (List separately in addition to code for primary service)Used if therapeutic infusion extends beyond the initial hour for IV-administered drugs.
    96372Therapeutic, prophylactic, or diagnostic injections (specify substance or drug); subcutaneous or intramuscularUsed for single subcutaneous injections that may be given in lieu of or prior to setting up a short subcutaneous infusion pump.
    36561Insertion of tunneled centrally inserted central venous catheter, with subcutaneous port or pump, age 5 years or olderRelated when a permanent subcutaneous port or pump reservoir is placed and later accessed for infusions; represents the device placement step in a broader workflow.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    363L00000X
    208D00000X
    208000000X
    367500000X
    207RM1200X
    261QR0400X
    246ZC0007X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C20Malignant neoplasm of rectum
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.912Malignant neoplasm of unspecified site of left female breast
    C61Malignant neoplasm of prostate
    C67.9Malignant neoplasm of bladder, unspecified
    C71.9Malignant neoplasm of brain, unspecified
    D50.9Iron deficiency anemia, unspecified

    Showing 1–10 of 28

    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-96367-ADDITIONAL-INTRAVENOUS-INFUSION-DIFFERENT-SUBSTANCE-UP-TO-1-HOUR

    CPT 96367: Additional IV Infusion of Different Medication, Up to 1 Hour

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

    CPT 96368: Concurrent Intravenous Infusion of Multiple Medications

    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.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.