General Question for the Week of October 21, 2024

Question:

How should the administration of an IV infusion lasting longer than 1 hour but less than 91 minutes be reported? At what point should the code 96415 be used for “each additional hour” of infusion?

Answer:

For IV infusion longer than 1 hour but less than 91 minutes, report only 96413. Do not report 96415 for “each additional hour” until more than 30 minutes have elapsed in addition to the prior hour of infusion.

This question was answered in our Coding Essentials for Infusion & Injection Therapy Services. For more hot topics relating to infusion services, please visit our store or call us at 1.800.252.1578, ext. 2.

TAGS: Compliance, Infusion & Injections, Medicare

CPT® copyright 2023 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Looking for an answer?

Compliance Question Archive

Sign Up for Compliance Question of the Week