Bundling Rule Updates for Drug Administration Codes

Effective July 28, 2021, in accordance with Current Procedural Terminology (CPT) guidelines, the administration fee for injectable(s) 96372 – 96379 may be submitted in addition to the code for the drug(s) or substance(s).   In order to consider reimbursement for 96372-96379, an allowable drug or substance service code must be filed on the same claim.  If the administered drug or substance was not supplied by the professional provider, the drug or substance being administered should still be filed on the claim with a $.01 charge.

CPT codes 96372-96379 are considered incidental to evaluation & management services, regardless of modifier usage, when performed in the following places of service (POS): 19, 21, 22, 23, 24, 26, 51, 52, and 61.

These changes apply to the following lines of business: Administrative Services Only (ASO), fully insured membership, Blue Card IPP Host and the State Health Plan (SHP).