Policy No: 109
Date of Origin: 05/01/2009
Last Reviewed: 09/01/2018
Last Revised: 09/01/2015
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.
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".
Facility Place Of Service codes are:
19 — Off Campus-Outpatient
21 — Hospital Inpatient Hospital
22 — On Campus-Outpatient Hospital
23 — Emergency Room
24 — Ambulatory Surgical Center
25 — Birthing Center
31 — Skilled Nursing Facility
32 — Nursing Facility
34 — Hospice, Free Standing
51 — Inpatient Psychiatric Facility
52 — Psychiatric Facility Partial Hosp
54 — Intermediate Care Facility
61 — Comp Inpatient Rehab Facility
62 — Comp Outpatient Rehab Facility
65 — End-Stage Renal Dz Tx Facility
NCCI Policy Manual, current version, Chapter XI
Current Procedural Terminology (CPT) Manual, American Medical Association. Current year version
Your use of this Reimbursement Policy constitutes your agreement to be bound by and comply with the terms and conditions of the Reimbursement Policy Disclaimer.