{"id":15224,"date":"2022-03-08T19:41:17","date_gmt":"2022-03-08T19:41:17","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15224"},"modified":"2026-09-30T18:31:34","modified_gmt":"2026-09-30T13:01:34","slug":"chemotherapy-administration-coding-guidelines-2022","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/chemotherapy-administration-coding-guidelines-2022\/","title":{"rendered":"Chemotherapy Administration Coding Guidelines 2022"},"content":{"rendered":"<h2 dir=\"ltr\">Key Takeaways<\/h2>\r\n<ul dir=\"ltr\">\r\n<li>Chemotherapy administration coding guidelines allow only one initial service code (96360, 96365, 96374, 96409, 96413) per encounter unless separate IV sites are used.<\/li>\r\n<li>Reporting two initial service codes for separate IV access sites requires the appropriate modifier.<\/li>\r\n<li>Drug administration codes 96360\u201396379, 96401\u201396425, and 96521\u201396523 are billable by physicians only in office settings, not facilities.<\/li>\r\n<li>Drug administration tied to Medicare-approved ASC procedures is not separately reportable by physicians.<\/li>\r\n<li>CPT 99211 is bundled into chemotherapy administration codes, but 99202\u201399205 and 99212\u201399215 can be billed with modifier 25.<\/li>\r\n<li>Port flushing before or after drug administration is integral to the service and should not be billed as CPT 96523.<\/li>\r\n<li>CPT 96522 applies only to programmable implantable pumps and cannot be billed with 96416 or 96425, which include the initial pump fill.<\/li>\r\n<li>CPT 96368 allows one unit per encounter for concurrent infusion, and hydration given with chemotherapy is not separately reportable.<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">The Centers for Medicare &amp; Medicaid Services (CMS) recently published revised coding guidelines for CPT codes 90000 \u2013 99999. In this Blog, we shared CPT codes applicable for Chemotherapy Administration Coding and minor updates in guidelines.\u00a0<\/span><\/p>\r\n<h2 style=\"text-align: left;\"><strong>Chemotherapy Administration Coding Guidelines 2022<\/strong><\/h2>\r\n<h3 style=\"text-align: left;\"><strong>Reporting Initial Service Code<\/strong><\/h3>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">The CPT codes 96360, 96365, 96374, 96409, and 96413 describe \u2018initial\u2019 service codes. For a patient encounter, only 1 \u2018initial\u2019 service code may be reported unless it is medically reasonable and necessary that the drug or substance administrations occur at separate intravenous access sites. To report 2 different \u2018initial\u2019 service codes, you can use appropriate modifiers.<\/span><\/p>\r\n<h3 style=\"text-align: left;\"><strong>Using Correct POS<\/strong><\/h3>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">CPT codes 96360-96379, 96401-96425, and 96521-96523 are reportable by providers\/suppliers for services performed in physicians\u2019 offices. These drug administration services shall not be reported by providers\/suppliers for services provided in a facility setting such as a hospital outpatient department or emergency department. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Drug administration services performed in an Ambulatory Surgical Center (ASC) related to Medicare-approved ASC payable procedures are not separately reportable by providers\/suppliers. Hospital outpatient facilities may separately report drug administration services when appropriate. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">The term \u2018Physician\u2019 in this article refers to M.D.s, D.O.s, and other practitioners who bill Medicare claims processing contractors for services payable on the MPFS (Medicare Physician Fee Schedule).<\/span><\/p>\r\n<h3 style=\"text-align: left;\"><strong>Billing CPT 99211<\/strong><\/h3>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">The drug and chemotherapy administration HCPCS\/CPT codes 96360-96375, 96377 and 96401-96425 have been valued to include the work and practice expenses of CPT code 99211 (E&amp;M service, office or other outpatient visit, established patient, level I). <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Although CPT code 99211 is not reportable with chemotherapy and non-chemotherapy drug\/substance administration HCPCS\/CPT codes, other non-facility-based E&amp;M CPT codes (e.g., 99202- 99205, 99212-99215) are separately reportable with modifier 25 if the physician provides a significant and separately identifiable E&amp;M service.\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Since providers\/suppliers shall not report drug administration services in a facility setting, a facility-based E&amp;M CPT code (e.g., 99281- 99285) shall not be reported with a drug administration CPT code unless the drug administration service is performed at a separate patient encounter in a non-facility setting on the same date of service. In such situations, the E&amp;M code should be reported with modifier 25. <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Under the OPPS (Outpatient Prospective Payment System), hospitals may report drug administration services and facility-based E&amp;M codes (e.g., 99281-99285, G0463) if the E&amp;M service is significant and separately identifiable. In these situations, modifier 25 should be appended to the E&amp;M code.<\/span><\/p>\r\n<h3 style=\"text-align: left;\"><strong>Inappropriate Use of CPT 96523<\/strong><\/h3>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Flushing or irrigation of an implanted vascular access port or device prior to or subsequent to the administration of chemotherapeutic or non-chemotherapeutic drugs is integral to the drug administration service and is not separately reportable. Under these circumstances, do not report CPT code 96523.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">Billing \u2018refilling &amp; maintenance of an implantable pump\/reservoir for systemic drug delivery\u2019<\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">CPT code 96522 describes the refilling and maintenance of an implantable pump or reservoir for systemic drug delivery. The pump or reservoir must be capable of programmed release of a drug at a prescribed rate. CPT code 96522 shall not be reported for accessing a nonprogrammable implantable intravenous device for the provision of infusion(s) or chemotherapy administration.\u00a0<\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">CPT code 96522 (Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (e.g., intravenous, intra-arterial) and CPT code 96521 (Refilling and maintenance of portable pump) shall not be reported with CPT code 96416 (Initiation of prolonged intravenous chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump) or CPT code 96425 (Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours) requiring the use of a portable or implantable pump). CPT codes 96416 and 96425 include the initial filling and maintenance of a portable or implantable pump. CPT codes 96521 and 96522 are used to report subsequent refilling of the pump.<\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">CPT codes 96521 and 96522 shall not be reported for accessing or flushing an indwelling peripherally-placed intravenous catheter port (external to skin), subcutaneous port, or nonprogrammable subcutaneous pump. Accessing and flushing these devices is an inherent service facilitating these infusion(s) and is not reported separately.<\/span><\/p>\r\n<h3 style=\"text-align: left;\"><strong>Billing CPT Code 96368<\/strong><\/h3>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">A concurrent intravenous infusion of an antiemetic or other non-chemotherapeutic drug with intravenous infusion of chemotherapeutic agents may be reported separately as <a href=\"https:\/\/www.cms.gov\/Medicare\/Fraud-and-Abuse\/PhysicianSelfReferral\">CPT code<\/a> 96368 (Concurrent intravenous infusion). <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">CPT code 96368 may be reported with a maximum of one unit of service per patient encounter regardless of the number of concurrently infused drugs or the length of time for the concurrent infusion(s). Hydration concurrent with chemotherapy is not separately reportable.<\/span><\/p>\r\n<p style=\"text-align: left;\"><b>Medical Billers and Coders (MBC)<\/b> <span style=\"font-weight: 400;\">is a <a href=\"https:\/\/www.medicalbillersandcoders.com\/\">leading medical billing company<\/a> providing complete revenue cycle solutions. CPT\u00ae is a registered trademark of the American Medical Association (AMA). <\/span><\/p>\r\n<p style=\"text-align: left;\"><span style=\"font-weight: 400;\">We shared some of CPT codes and it\u2019s guidelines for reference purpose only, for accurate use please refer to detailed code description. If you need assistance in <a href=\"https:\/\/www.medicalbillersandcoders.com\/speciality\/oncology-medical-billing-services.html\">Chemotherapy Administration Coding service<\/a>, contact us at <\/span><span style=\"font-weight: 400;\"><a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a> \/\u00a0<\/span><a href=\"tel:888-357-3226\"><span style=\"font-weight: 400;\"> 888-357-3226<\/span><\/a><\/p>\r\n<h2 style=\"text-align: left;\"><strong>FAQs:<\/strong><\/h2>\r\n\r\n<div class=\"schema-faq wp-block-yoast-faq-block\">\r\n<div id=\"faq-question-1746894870808\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">1. What are the initial service CPT codes for chemotherapy administration?<\/strong>\r\n<p class=\"schema-faq-answer\">The initial service CPT codes include 96360, 96365, 96374, 96409, and 96413. Only one can be reported unless separate IV access sites are used.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746894888988\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">2. Can I report CPT code 99211 with chemotherapy administration codes?<\/strong>\r\n<p class=\"schema-faq-answer\">No, CPT code 99211 is included in the chemotherapy administration codes. Other E&amp;M codes may be reported separately with modifier 25 if a significant service is provided.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746894903898\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">3. Is flushing a vascular access port reportable separately?<\/strong>\r\n<p class=\"schema-faq-answer\">No, flushing an implanted vascular access port is integral to the drug administration service and should not be reported separately.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746894921034\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">4. What does CPT code 96522 cover?<\/strong>\r\n<p class=\"schema-faq-answer\">CPT code 96522 covers the refilling and maintenance of an implantable pump for systemic drug delivery. It should not be used for non-programmable devices.<\/p>\r\n<\/div>\r\n<div id=\"faq-question-1746894943438\" class=\"schema-faq-section\"><strong class=\"schema-faq-question\">5. Can I report CPT code 96368 for concurrent infusions?<\/strong>\r\n<p class=\"schema-faq-answer\">Yes, CPT code 96368 can be reported for a concurrent infusion of antiemetics with chemotherapy. Only one unit may be reported per encounter, regardless of the number of drugs.<\/p>\r\n<\/div>\r\n<\/div>\r\n","protected":false},"excerpt":{"rendered":"<p>Key Takeaways Chemotherapy administration coding guidelines allow only one initial service code (96360, 96365, 96374, 96409, 96413) per encounter unless separate IV sites are used. Reporting two initial service codes for separate IV access sites requires the appropriate modifier. Drug administration codes 96360\u201396379, 96401\u201396425, and 96521\u201396523 are billable by physicians only in office settings, not [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":15225,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[3278,120,3281,2580,3282,3283],"class_list":["post-15224","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-oncology-billing-services","tag-chemotherapy-administration-coding","tag-cpt-code","tag-cpt-code-99211","tag-em-code","tag-em-cpt-codes","tag-hcpcs-cpt-codes"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.5 (Yoast SEO v28.5) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Chemotherapy Administration Coding Guidelines 2022<\/title>\n<meta name=\"description\" content=\"Our Billing Experts shared CPT codes applicable for 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The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/author\\\/seo2\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/chemotherapy-administration-coding-guidelines-2022\\\/#faq-question-1746894870808\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/chemotherapy-administration-coding-guidelines-2022\\\/#faq-question-1746894870808\",\"name\":\"1. What are the initial service CPT codes for chemotherapy administration?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"The initial service CPT codes include 96360, 96365, 96374, 96409, and 96413. Only one can be reported unless separate IV access sites are used.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/chemotherapy-administration-coding-guidelines-2022\\\/#faq-question-1746894888988\",\"position\":2,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/chemotherapy-administration-coding-guidelines-2022\\\/#faq-question-1746894888988\",\"name\":\"2. Can I report CPT code 99211 with chemotherapy administration codes?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"No, CPT code 99211 is included in the chemotherapy administration codes. 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