Summary & Overview
CPT 96370: Subcutaneous Infusion, Additional Hour
CPT code 96370 designates the additional-hour billing for a medication infused through an already established subcutaneous infusion site and pump. This code matters nationally because it captures ongoing infusion time beyond initial setup, affecting reimbursement for continuous subcutaneous therapies administered in ambulatory infusion centers, home infusion programs, and other outpatient settings. Proper use of this code supports accurate payment for prolonged therapeutic or preventive infusions and aligns billing with the duration of service provided.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for continuous subcutaneous pump infusions, explanations of service lines and typical sites of service, and a summary of common billing considerations. The publication also covers benchmarks and policy updates relevant to time-based infusion coding, and provides guidance on how CPT code 96370 is used in claims documentation and medical record alignment. Data not available in the input is clearly noted where applicable.
Billing Code Overview
CPT code 96370 describes the infusion of a medication through a previously established subcutaneous infusion site and pump set up, billed for each additional hour of administration. The service reflects ongoing delivery of a drug or substance for prevention or therapeutic purposes when an infusion site and pump are already in place.
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Service type: Continuous subcutaneous infusion (additional hour increments)
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Typical site of service: Settings where a subcutaneous infusion pump is established, such as outpatient infusion centers, home infusion services, or other ambulatory care locations where a pump and infusion site are maintained
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving a continuous subcutaneous infusion pump (for example, for parenteral hydration, analgesic infusion, or antiemetic therapy) who requires extension of an ongoing infusion beyond the initial hourly period. The patient presents to an outpatient infusion clinic, home health nurse visit, or hospital unit where a previously established subcutaneous infusion site and pump are already in place. The provider assesses the existing infusion site and pump set-up, confirms the medication and infusion rate, and documents continuation of the infusion for each additional hour using the existing access. The workflow includes verifying patient identity and orders, inspecting the infusion site and pump tubing for integrity, confirming that no new venous access is required, adjusting the pump to continue infusion for another hour block, and documenting time-based service, medication administered, and clinical rationale in the medical record. Typical settings include outpatient infusion centers, home health visits, hospice care, and inpatient units where the infusion site was established earlier and continuation is medically necessary.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Rarely used; avoid when a more specific modifier applies |
11 |