CPT 96379 Reimbursement & Benchmarks | OpenPayer

Summary & Overview

CPT 96379: Unspecified IV or Intraarterial Injection/Infusion Procedure

CPT code 96379 designates therapeutic, prophylactic, or diagnostic intravenous or intraarterial injection or infusion procedures that lack a more specific CPT descriptor. Nationally, it functions as a catch‑all code for uncommon or otherwise unspecified IV/intraarterial administrations, making correct use important for encounter reporting, claims processing, and clinical documentation.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical scope and typical sites of service, plus national benchmarking context where available. The publication describes common payer coverage patterns, relevant modifiers, and coding considerations that influence claim adjudication and reimbursement recognition.

This summary equips billing managers, coders, and clinician leaders with the information needed to identify when 96379 applies, understand payer relevance, and anticipate areas of policy variability. Data not available in the input is noted where applicable, and readers seeking payer‑specific policy language should consult individual insurer manuals.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 96379intravenous infusionintraarterial injectioninfusion codingmedical billingambulatory careunspecified procedure codeinfusion servicesclinical documentation

Billing Code Overview

CPT code 96379 reports therapeutic, prophylactic, or diagnostic intravenous or intraarterial injection or infusion procedures that do not have a more specific CPT code. This code is intended for use when an IV or intraarterial administration procedure is performed but is not described elsewhere in the CPT code set.

Service type: Intravenous or intraarterial injection/infusion procedures (unspecified)

Typical site of service: Ambulatory clinics, hospital outpatient departments, physician offices, or other settings where IV or intraarterial injections or infusions are delivered

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult receiving an unlisted therapeutic intravenous infusion when no specific CPT code exists for the drug, route, or clinical scenario. Example: a 58-year-old patient with refractory autoimmune disease admitted to an outpatient infusion center for a specialty biologic administered intravenously that does not map to an existing infusion code. The clinical workflow: order placed by the treating physician, medication prepared by pharmacy, vascular access established (peripheral IV or existing central line), infusion administered under nursing supervision, patient monitored for infusion reactions, documentation of drug name, dose, route, start/stop times, and any complications. Billing uses 96379 when the infusion/injection is therapeutic, prophylactic, or diagnostic and no specific CPT code applies; an appropriate modifier may be appended to report unusual circumstances (for example, modifier 22 for increased procedural services or modifier 52 for reduced services).

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier / standard reporting	When no special reporting modifier applies to the service billed with .

CPT 96372: Therapeutic, Prophylactic, or Diagnostic Injection Administration

96373-THE-PROVIDER-ADMINISTERS-A-MEDICATION-OR-OTHER-SUBSTANCE

CPT 96373: Intra-Arterial Medication Administration

96365-INTRAVENOUS-INFUSION-FOR-THERAPY-PROPHYLAXIS-OR-DIAGNOSIS

CPT 96365: Initial Intravenous Infusion for Therapy, Prophylaxis, or Diagnosis

96375-INTRAVENOUS-INFUSION-FOR-TREATMENT-PROPHYLAXIS-OR-DIAGNOSIS

CPT 96375: Intravenous Sequential Infusion of a New Drug

CPT-96381-RSV-MONOCLONAL-ANTIBODY-SEASONAL-IM-INJECTION

CPT 96381: Seasonal RSV Monoclonal Antibody Intramuscular Injection

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

CPT 96368: Concurrent Intravenous Infusion of Multiple Medications

96367-THERAPEUTIC-PROPHYLACTIC-AND-DIAGNOSTIC-INFUSIONS

CPT 96367: Sequential Intravenous Infusion of New Substance, Up to 1 Hour

CPT-96377-ON-BODY-SUBCUTANEOUS-INJECTOR-APPLICATION

CPT 96377: On-Body Injector Application for Subcutaneous Timed Delivery

CPT-96371-SUBCUTANEOUS-PORT-SITE-ESTABLISHMENT-AND-INFUSION-PUMP-SETUP

CPT 96371: Subcutaneous Port Site Establishment and Infusion Pump Setup

96374-THERAPEUTIC-PROPHYLACTIC-OR-DIAGNOSTIC-INJECTION-SPECIFY

CPT 96374: Intravenous Push Injection, Single or Initial Drug

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96379

Taxonomy Code	Specialty	Notes
208000000X	Hematology & Oncology	Common specialty administering complex IV therapeutic infusions, biologics, and chemotherapy.
207Q00000X	Allergy & Immunology	Frequently administers IV immunotherapies and biologic treatments requiring unlisted infusion reporting.
163W00000X	Infusion Therapy	Nurses and infusion specialists responsible for administration and monitoring of IV infusions in outpatient settings.
207L00000X	Rheumatology	Administers IV biologics and specialty agents for autoimmune conditions when no specific infusion code exists.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M05.79`	Rheumatoid arthritis with rheumatoid factor, multiple sites	IV biologic therapy for severe rheumatoid disease when specific infusion codes may not apply.
`D89.89`	Other specified diseases of the immune system	Use when infusions (e.g., immunoglobulin or biologics) are given for other immune disorders without a specific code.
`G35`	Multiple sclerosis	Infusion of disease-modifying agents or monoclonal antibodies administered IV for relapsing disease.
`M32.10`	Systemic lupus erythematosus, organ or system involvement unspecified	IV therapies such as immunosuppressants or biologics administered when no specific infusion CPT exists.
`J99.8`	Other respiratory disorders due to diseases classified elsewhere	For select diagnostic or therapeutic IV infusions related to systemic disorders affecting respiration.
`D70.9`	Neutropenia, unspecified	Therapeutic IV infusions (e.g., growth factors) administered when no specific infusion code applies.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Used when the infusion can be reported with a specific initial infusion code instead of `96379` for standard-duration infusions.
`96366`	Intravenous infusion; each additional hour (List separately in addition to code for primary infusion)	Used to report additional time-based infusion units when infusion duration extends beyond the initial hour.
`96413`	Chemotherapy administration, intravenous infusion technique; each additional hour	Relevant when chemotherapy agents are infused and a chemotherapy-specific code is applicable rather than `96379`.
`96374`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug	Used when the medication is administered as an IV push with a specific injection code available instead of `96379`.
`36556`	Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older	Performed before infusion when central venous access is required for administration of complex or high-risk infusates.

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