The 96365 CPT code is essential for billing the initial hour of IV infusion therapy. This code is widely used for therapeutic, prophylactic, or diagnostic infusions. Proper use ensures that infusion practices are reimbursed accurately and helps prevent claim denials.
Infusion Billing Services specializes in managing complex infusion billing, helping practices correctly use 96365 for optimal reimbursement.
What Is the 96365 CPT Code?
The 96365 CPT code represents the initial intravenous infusion of a drug or therapy, up to one hour. It is used for medications such as:
Chemotherapy drugs
Biologics
Immunotherapy medications
IV hydration
Accurate coding of 96365 is critical because payers review infusion claims closely, particularly when high-cost medications are involved.
Documentation Requirements
Documentation is vital for 96365 billing. Key elements include:
Start and stop times of the infusion
Name and dosage of the medication
Route of administration
Medical necessity and treatment plan
Incomplete documentation is a leading cause of denials. Infusion Billing Services ensures your practice maintains detailed records to support every claim.
Common Mistakes
Common errors with 96365 include:
Confusing the initial infusion with subsequent hours
Failing to document infusion duration accurately
Misaligning the CPT code with diagnosis or J-codes
Using the code for infusions under 16 minutes
Avoiding these errors ensures faster reimbursement and a smoother revenue cycle.
Best Practices
Record exact infusion start and stop times
Align CPT codes with ICD-10 and J-codes
Verify medical necessity for each infusion
Review payer-specific rules regularly
Conduct internal audits to ensure compliance
How Infusion Billing Services Can Help
Infusion Billing Services provides expertise in CPT coding, including 96365. Their services include:
Accurate claim submission
Documentation review and compliance
Denial management and appeals
Optimized revenue cycle for infusion centers
Conclusion
The 96365 CPT code is critical for IV infusion billing. Proper documentation, accurate coding, and expert guidance from Infusion Billing Services help practices reduce denials, speed up reimbursement, and maintain compliance. Accurate use ensures infusion centers are fairly compensated while focusing on patient care.