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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-96372-subcutaneous-intramuscular-injection-therapeutic-prophylactic-diagnostic
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    CPT 96372: Intramuscular or Subcutaneous Therapeutic Injection

    Medicare pays $16 and commercial payers pay $48 on average nationally for this procedure.

    CPT code 96372 describes a therapeutic, prophylactic, or diagnostic substance administered by intramuscular or subcutaneous injection by a physician or under direct physician supervision; this is an injection procedure typically performed in outpatient clinic, office, or ambulatory care settings for single-drug administration (vaccines and toxoids are excluded).

    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

    Across national payers, Medicare's average reimbursement for CPT 96372 sits at $15.9, substantially below BUCA’s mean commercial level of $48.4, underscoring a sizable gulf between Medicare and average commercial pricing. This gap reflects Medicare’s more constrained mean compared with commercial plans, with BUCA roughly three times higher than Medicare on average.

    Dispersion (P75 minus P25) varies meaningfully: Aetna shows a spread of $35.0, Blue Cross Blue Shield a spread of $39.4, BUCA a spread of $29.3, Cigna a spread of $18.1, Medicare a tight spread of $1.0, and UnitedHealth Group a spread of $15.2. Blue Cross Blue Shield exhibits the widest interquartile range, while Medicare is the tightest; Cigna and UnitedHealth Group are also relatively narrow compared with Aetna and BUCA.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old patient presents to a family medicine clinic following reported recent sexual exposure to a partner with HIV. The clinician evaluates risk, confirms indication for HIV post‑exposure prophylaxis (PEP) or discussion of pre‑exposure prophylaxis (PrEP) depending on history, and determines the need for an immediate subcutaneous or intramuscular injection of a therapeutic agent (for example, a single‑dose antiretroviral injection when indicated or other prophylactic agent). Under direct physician supervision, a nurse prepares and administers the injection using aseptic technique, documents the drug name, dose, route (IM or SC), lot number, and site, and monitors the patient briefly for immediate adverse reaction before discharge. Typical workflow includes intake and risk assessment, informed consent discussion, medication selection and preparation, administration using 96372 for the IM/SC injection (vaccine/toxoid injections are excluded from this code), post‑administration observation, and documentation of ICD‑10 code Z20.6 for exposure or Z29.81 for PrEP encounter as applicable.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96377Application of on‑body injector (includes cannula insertion) for timed subcutaneous injection

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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.,…
    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…
    90Modifier ‑90 (Reference/Outside Laboratory) indicates that a laboratory test was performed by an entity other than the treating or reporting provider. The American Medical Association defines…- Use CPT modifier -90 when a laboratory test is performed by an outside/reference laboratory (an entity other than the treating or reporting physician or qualified professional) and the claim needs…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208D00000X
    207RG0100X
    2279H0200X
    207RH0000X
    163WG0000X
    2278P1006X
    3336C0004X
    133VN1401X

    Related ICD-10-CM Codes

    2 rows

    ICD-10-CM CodeDescription
    Z29.81Encounter for HIV pre-exposure prophylaxis
    Z20.6Contact with and (suspected) exposure to human immunodeficiency virus [HIV]

    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-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-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.

    Alternative procedure code used instead of 96372 when an on‑body injector device (e.g., Onpro/ONBODY) is applied rather than a standard IM/SC manual injection.