Injection and Infusion Services

Policy No: 109
Date of Origin: 05/01/2009
Section: Administrative
Last Reviewed: 10/01/2023
Last Revised: 10/01/2019
Approved: 10/12/2023
Effective: 11/01/2023
Policy Applies To: Group and Individual & Medicare Advantage

This policy applies only to physicians and other qualified health care professionals.

Injection and Infusion Services
An injection or medication administered subcutaneously, intramuscular or intravenously. Common Procedural Terminology (CPT®) identifies these services that are not intended to be reported by a physician when the service is provided in a facility setting.

Our health plan will not reimburse or permit a provider to retain reimbursement for services that are not intended to be performed by a physician in a facility setting. These physician charges will be denied as a provider write-off. Ambulatory Surgical Centers (ASC), with a provider type of BZ, are excluded from this policy.

Examples of these services are CPT codes 96360-96379 for infusion therapy and CPT codes 96401-96402, 96409-96425 and 96521-96523 for Chemotherapy. CPT text states: "These Injection and Infusion Services codes are not intended to be reported by the physician or other qualified health care professional in the facility setting".

NCCI Policy Manual, current version, Chapter XI

Current Procedural Terminology (CPT®) Manual, American Medical Association. Current year version

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