Chemotherapy General Infusion Information

There are CPT codes for several different types of infusions and injections for drugs and biologicals. These include codes for chemotherapy infusions and injections, therapeutic, prophylactic and diagnostic infusions, injections and hydration.

The CPT manual published by the AMA describes chemotherapy drugs and biologicals, infusions and injections (CPT codes 96401–96549) as requiring “physician work and/or clinical staff monitoring well beyond that of therapeutic drug agents (CPT codes 96360–96379) because the incidence of severe adverse patient reactions are typically greater” (CPT Coding Guidelines). These codes are paid at a higher rate to reflect the greater physician work and other resources required to safely administer these substances.

For the therapeutic, prophylactic and diagnostic infusions and injections codes, the CPT states that:

“...if performed to facilitate the infusion or injection, the following services are included and are not reported separately:

• Use of local anesthesia
• IV start
• Access to indwelling IV, subcutaneous catheter or port
• Flush at conclusion of infusion; and
• Standard tubing, syringes, and supplies” (CPT Coding Guidelines).

The CPT defines hydration as “prepackaged fluid and electrolytes… not the infusion of drugs or other substances.” “Typically, such infusions require little special handling to prepare or dispose of, and staff that administer these do not typically require advanced practice training. After initial set up, infusion typically entails little patient risk and thus little monitoring” (CPT Coding Guidelines).

Payment for hydration codes/fluids requires the documentation to support the medical necessity of the hydration services. Hydration codes should not be billed when the fluids are incidental or of a “keep open” nature.

Posted 3/26/2024