CPT 96375: IV Push Sequential Drug Infusion (New Drug Add-On)
Medicare pays $16 and commercial payers pay $65 on average nationally for this procedure.
CPT code 96375 describes the sequential administration of a different medication via intravenous (IV) push following an initial IV push, performed for therapeutic, prophylactic, or diagnostic purposes; this represents an IV push sequential drug infusion service typically provided in outpatient infusion suites or hospital outpatient departments and occasionally in physician office settings.
For related coverage guidance, see recent payer policy updates: Esophagogastroduodenoscopy (EGD) Coverage Policy, Magnetic Sphincter Augmentation for the Treatment of Gastroesophageal Reflux Disease (GERD), Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing.
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National Reimbursement Benchmarks
Commercial averages for BUCA and Medicare diverge notably: BUCA’s mean rate is $65.40 versus Medicare’s mean of $16.40, so BUCA averages about $49.00 higher than Medicare. This underscores a substantial commercial–Medicare gap for CPT 96375, with BUCA positioned near the upper end of national commercial means while Medicare remains tightly clustered around mid-teens.
Dispersion measured by the interquartile range (P75–P25) varies across payers. Blue Cross Blue Shield has a P75–P25 of $51.06, Aetna $53.20, UnitedHealth Group $16.70, Cigna $18.10, and BUCA $37.30; Medicare’s IQR is $2.00. Aetna and Blue Cross Blue Shield exhibit the widest IQRs, indicating greater rate spread, while Medicare, UnitedHealth Group, and Cigna are comparatively tight, with Medicare being the narrowest.