Summary & Overview
CPT 96371: Subcutaneous Port Site Establishment and Infusion Pump Setup
CPT code 96371 captures the clinical service of creating a new subcutaneous port site, establishing an infusion pump, and delivering a medication via that pump for prevention or therapy. This procedure is relevant across oncology, pain management, and long-term infusion therapy programs where subcutaneous access and pump-based delivery are required. Nationally, accurate coding of this service affects coverage determinations, site-of-service reporting, and procedural activity counts for outpatient infusion services.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical and billing scope of 96371, common payer considerations, and the policy and billing context surrounding pump-based subcutaneous infusion starts. The report outlines where the service is typically delivered (outpatient infusion centers and ambulatory surgical settings) and summarizes typical documentation elements used to support medical necessity.
This publication provides benchmarks and policy context relevant to hospitals, physician practices, and infusion providers. It is designed to help coding managers, billing professionals, and clinical leaders understand what CPT code 96371 represents, how it is used in practice, and what to expect from major national payers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 96371 describes a procedure in which the provider establishes a subcutaneous port site in a new location, sets up an infusion pump, and administers a medication via that pump for preventive or therapeutic purposes. This service involves preparing a subcutaneous access site and initiating infusion using an external or implantable infusion device.
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Service type: Subcutaneous port site placement and infusion setup with drug administration
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Typical site of service: Outpatient infusion center or ambulatory surgical setting where subcutaneous port access and pump-based infusion are performed
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with metastatic colorectal cancer requires long-term intermittent subcutaneous infusion therapy for chemotherapy or supportive medications (e.g., hydration, antibiotics, antiemetics). The clinician selects a new subcutaneous port site because the previous port is infected or nonfunctional. In the outpatient infusion center or ambulatory surgical suite, the provider prepares the patient, establishes a subcutaneous port pocket in a new location, connects and programs an ambulatory infusion pump, primes tubing, and administers the prescribed medication via the pump. Nursing monitors vital signs and the infusion site during and after the procedure, documents device setup, pump settings, medication name/dose, and provides patient education on pump care and troubleshooting prior to discharge. Typical site of service: outpatient infusion center, ambulatory surgical center, or hospital outpatient department. Service type: interventional device placement with infusion administration and pump setup for therapeutic or prophylactic medication delivery.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Provider's usual/typical service | Use when this is the routine service provided by the reporting clinician. |
22 |