Giving a drug is billed separately from the drug itself. The drug goes on its own line with its HCPCS code (often a J-code), units and NDC; the injection or infusion is a CPT code from the drug administration section — 96360–96379 for hydration, therapeutic injections and infusions, 96401–96549 for chemotherapy and other highly complex drugs, and 90460–90474 for vaccines.
Two lines: the drug and the service
A clinician-administered drug is usually reported on two lines. The drug line carries the HCPCS Level II code for the product, the units based on the dose, and the 11-digit NDC. The administration line carries a CPT code for the way the drug was given and, for infusions, how long it ran.
Med-Code describes the CPT codes below in its own words. CPT descriptors and guidelines are licensed by the AMA; use the current CPT code book or a licensed coding product for the exact wording and rules.
Injections and IV pushes (non-chemotherapy)
| CPT | What it covers (Med-Code summary) |
|---|---|
| 96372 | Injection under the skin or into a muscle, for treatment, prevention or diagnosis |
| 96373 | Injection into an artery |
| 96374 | IV push, the first or only drug |
| 96375 | IV push of each additional, different drug |
| 96376 | IV push of the same drug again (facility reporting) |
| 96377 | Applying an on-body injector |
Infusions (non-chemotherapy)
Infusion codes are time-based, and a very short infusion may be reported as an IV push instead. When several services happen in one visit, one is reported as the initial service and the rest as additional or sequential; facilities and physician offices follow different rules for which comes first.
| CPT | What it covers (Med-Code summary) |
|---|---|
| 96360 / 96361 | Hydration by IV infusion: first hour / each additional hour |
| 96365 / 96366 | IV infusion of a drug for treatment, prevention or diagnosis: first hour / each additional hour |
| 96367 | An additional, different drug infused in sequence |
| 96368 | A drug infused at the same time as another (concurrent) |
| 96369 / 96370 / 96371 | Subcutaneous infusion: first hour / each additional hour / an additional pump set-up |
Chemotherapy and other highly complex drugs
The chemotherapy administration codes are also used for other drugs that need similar handling and monitoring, such as many monoclonal antibodies. Whether a drug qualifies is a payer and CPT-guideline question, not something the drug's J-code decides.
| CPT | What it covers (Med-Code summary) |
|---|---|
| 96401 / 96402 | Injection under the skin or into a muscle: non-hormonal anti-cancer drug / hormonal anti-cancer drug |
| 96409 / 96411 | IV push: first drug / each additional drug |
| 96413 / 96415 | IV infusion: first hour / each additional hour |
| 96416 | Starting a prolonged infusion with a portable or implanted pump |
| 96417 | An additional, different drug infused in sequence |
Vaccines
Vaccines are the exception on the drug side: the vaccine has a CPT product code (mostly 90476–90759), and giving it is reported with an immunization administration code — 90471 and 90472 for injections, 90473 and 90474 for nasal or oral vaccines, and 90460 and 90461 for patients under 19 when the clinician counsels on the vaccine. Medicare uses HCPCS G0008, G0009 and G0010 for flu, pneumococcal and hepatitis B vaccine administration.
Questions
What is the CPT code for an injection of medication?
For a drug injected under the skin or into a muscle, the administration is usually CPT 96372. The drug itself is billed on its own line with its HCPCS code, units and NDC.
Is a J-code a CPT code?
No. J-codes are HCPCS Level II codes from CMS that identify the drug. CPT codes, from the AMA, describe the service of giving it.
Do self-administered drugs need an administration code?
No. A drug the patient injects at home is usually dispensed by a pharmacy and billed by NDC on a pharmacy claim, with no CPT administration code.