CPT Code 96372: Therapeutic, prophylactic, or diagnostic injection

What is CPT code 96372?

CPT procedural code 96372 is part of the Current Procedural Terminology (CPT) system, a standardized coding set that describes medical, surgical, and diagnostic procedures. The American Medical Association maintains that CPT codes are essential in healthcare and medical billing. Specifically, CPT 96372 is used to report the administration of a therapeutic, prophylactic, or diagnostic substance via intramuscular injection (IM) or subcutaneous injection (SC). It is typically performed by healthcare providers or their qualified staff under direct supervision.

Medical necessity must be documented when reporting this code to ensure appropriate use. The Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) includes guidelines to prevent incorrect coding and improper payments. The Medicare Claims Processing Manual also offers further instructions for properly reporting and reimbursing CPT 96372.

CPT code 96372 documentation requirements

Because proper documentation is needed to support its use and ensure proper healthcare billing, providers must clearly include the following:

• Medication details (name of drug administered, dosage, route [SC or IM], and lot number)
• Injection site (anatomical location)
• Medical necessity (diagnosis or reason for the injection linked to a covered condition or treatment plan)
• Provider involvement (administered by a licensed or qualified healthcare professional)
• Time and effort (reflects preparation, administration, and immediate monitoring)

Correctly using this code helps simplify the billing process.

CPT code 96372 billing guidelines

To ensure accurate billing and reimbursement, some billing guidelines must be considered, such as:

• Exclusion of chemotherapy drugs
• Single or initial injection only (applies to one injection; multiple injections may need modifiers or different codes)
• Separate procedure designation (can only be billed separately if not bundled with another procedure during the same visit)
• Modifier use when needed (e.g., use Modifier 59 if the injection is distinct from another service provided on the same day to the same patient)

With proper documentation and the support of quality billing software, healthcare providers can ensure accurate claims and timely reimbursement.