Last reviewed: May 23, 2026 · AMA CPT manual · CMS IOM Pub 100-04 Ch.12 §30.5 · NCCI manual Ch.XI · Methodology
A working reference for the CPT codes that report how a specialty drug is delivered — the time and route of administration that lives next to the J-code on every infusion claim. The administration code drives a separate facility/professional reimbursement line and is where coders most often under-bill (missing 96366 add-on units) or over-bill (96360 bundled with a drug infusion). Each code family below has its own deep-dive page with the decision tree, hour-counting rules, modifier overlay, NCCI bundling edits, worked examples on real J-codes, and per-payer divergence from CMS.
Sprint 1B covers the eight code families that account for nearly all specialty drug administration billing. Each entry links to a deep-dive page with rules, worked examples, and per-payer notes.
| CPT code(s) | What it reports | Deep-dive page |
|---|---|---|
| 96360 | IV hydration, initial 31 minutes to 1 hour. Separately billable only when the hydration is medically necessary beyond drug delivery (pre-chemo nephroprotection, dehydration treatment). | 96360 / 96361 → |
| 96361 | IV hydration, each additional hour. Add-on to 96360. Same ≥31 minute hour rule. | 96360 / 96361 → |
| 96365 | Therapeutic, prophylactic, or diagnostic IV infusion, initial up to 1 hour. Non-chemo biologics: Remicade, Ocrevus, Rituxan, Stelara IV, IVIG, Soliris, Entyvio. | 96365 / 96366 → |
| 96366 | Therapeutic IV infusion, each additional hour. Add-on to 96365 or 96413. Most under-billed code in non-chemo biologic infusion — multi-hour Ocrevus and IVIG runs routinely miss 96366 units. | 96365 / 96366 → |
| 96367 | Sequential infusion of an additional drug or substance, up to 1 hour. Used when a second drug runs after the primary infusion through the same access. Detail page planned (not yet built). | — |
| 96368 | Concurrent infusion of an additional drug or substance. Reported once per encounter regardless of how many concurrent drugs run. Detail page planned (not yet built). | — |
| 96369 / 96370 / 96371 | Subcutaneous infusion via pump for SCIG products (Hizentra, Cuvitru, Cutaquig, Xembify, Gamunex-C SC). 96369 initial + 96370 each additional hour + 96371 each additional pump set-up at a new site. | 96369 / 96370 / 96371 → |
| 96372 | Therapeutic, prophylactic, or diagnostic injection — subcutaneous or intramuscular. Non-chemo. Examples: depot leuprolide, denosumab (Prolia/Xgeva), Hizentra setup injections. Detail page planned (not yet built). | — |
| 96374 / 96375 / 96376 | Therapeutic IV push (non-chemo): 96374 initial, 96375 each additional new drug, 96376 each additional same drug (HOPD-only). Used when drug is administered over 15 minutes or less. | 96374 / 96375 / 96376 → |
| 96401 | Chemotherapy administration, subcutaneous or intramuscular, non-hormonal anti-neoplastic. | 96401 / 96402 → |
| 96402 | Chemotherapy administration, subcutaneous or intramuscular, hormonal anti-neoplastic (e.g., depot leuprolide for prostate cancer, when billed under chemo classification per payer). | 96401 / 96402 → |
| 96409 / 96411 | Chemotherapy IV push: 96409 initial single substance + 96411 each additional. Vincristine, doxorubicin push, 5-FU bolus in FOLFOX/FOLFIRINOX, R-CHOP push agents. | 96409 / 96411 → |
| 96413 / 96415 | Chemotherapy IV infusion: 96413 initial up to 1 hour + 96415 each additional hour. Carboplatin, cisplatin, ADCs (Enhertu, Kadcyla, Trodelvy), checkpoint inhibitors (Keytruda, Opdivo, Tecentriq). | 96413 / 96415 → |
| 96417 | Each additional sequential chemotherapy push or infusion of a new substance (different drug, same encounter). Used after 96413 or 96409 as add-on. R-CHOP and multi-drug regimens. | 96417 → |
| 67028 | Intravitreal injection of a pharmacologic agent (ophthalmology). Eylea, Eylea HD, Lucentis, Vabysmo, Beovu, Cimerli, Byooviz. Requires anatomic modifier RT/LT/50 on every claim. | 67028 → |
| 96413 | Chemotherapy IV infusion, initial up to 1 hour. Anti-neoplastic drugs and monoclonal antibodies that meet the AMA chemo administration definition. | 96413 / 96415 → |
| 96415 | Chemotherapy IV infusion, each additional hour. Add-on to 96413. | 96413 / 96415 → |
The AMA hierarchy is route → classification → duration → sequencing. The right code for any drug encounter falls out of those four questions in order.
Patient receives a 2-hour Remicade (infliximab, J1745) infusion. No other drugs, no hydration beyond the carrier fluid.
→ 96365 (initial hour) + 96366 × 1 (the second hour). One administration encounter, two CPT lines for time.
Patient receives 90 minutes of carboplatin (J9045) as monotherapy.
→ 96413 (initial hour) + 96415 × 1 (the additional 30+ minutes counts as a full hour under the ≥31-minute rule). 96365/96366 would be wrong — chemotherapy classification trumps therapeutic infusion.
Patient receives 1-hour Herceptin (J9355) then 1-hour Taxol (J9267) through the same IV.
→ 96413 for the Taxol (chemotherapy is the initial-service code, regardless of order administered) + 96369 / 96370 / 96371 for the sequential Herceptin (non-chemo biologic following the chemo). One initial code per encounter.
Patient receives 1 hour of saline hydration (1L NS) before 1 hour of cisplatin per NCCN nephroprotection guidelines, then another 1 hour of saline post-infusion.
→ 96413 for the cisplatin + 96361 × 1 for the post-hydration. Pre-hydration is typically bundled into the initial-service hour; some payers accept 96360 for the pre-hydration when documented as protocol-driven, separate from drug carrier fluid. Cite nephroprotection ICD-10 (Z51.81 or N17.x).
Patient receives 10 mg dexamethasone IV push as pre-medication.
→ 96374. Push is defined as administration over 15 minutes or less, manually injected, or as an infusion that runs 15 minutes or less.
Patient receives subcutaneous Prolia (denosumab, J0897) 60 mg.
→ 96372. Prolia is non-chemo; 96401/96402 are for anti-neoplastic SC/IM only. Documentation should support the SC route and the 60 mg dose.
Most HCPCS modifiers attach to the J-code, not the administration code. The exceptions are the 59/X{EPSU} distinct-procedural-service family (which can attach to admin codes to break NCCI bundles) and KX (which attaches to whichever line the LCD designates — usually the J-code, occasionally the admin code for IVIG and similar LCDs).
| Modifier | Attaches to J-code | Attaches to admin code | Notes |
|---|---|---|---|
| JW / JZ | Yes | No | JW/JZ are HCPCS modifiers reporting drug waste — they describe the drug, not the time. |
| JG | Yes | No | JG identifies the drug as 340B-acquired; does not attach to the administration line. |
| KX | Yes (typical) | Per LCD | For most LCDs, KX goes on the J-code. Some MAC IVIG LCDs require KX on the administration code as well. |
| 59 / XE / XS / XP / XU | No | Yes | Used to indicate distinct procedural service when NCCI bundles two admin codes that the encounter genuinely requires separately. |
| RT / LT / E1-E4 | Per payer | No | Anatomic modifiers attach to the procedure code that has anatomic specificity (e.g., CPT 67028 for intravitreal injection). |
| 25 (E&M) | No | No | Modifier 25 attaches to a separately identifiable E&M visit on the same day, not to the J-code or the admin code. |
Mapping the most common specialty drug classes to the administration code they generate. This is a quick-lookup grid; the deep-dive pages have the line-item math.
| Drug class | Examples (J-code) | Primary admin code | Add-on / sequence |
|---|---|---|---|
| Non-chemo monoclonals | Remicade J1745, Ocrevus J2350, Rituxan J9312, Stelara IV J3357 | 96365 | 96366 × n (each additional hour) |
| IVIG | Privigen J1459, Gammagard J1569, Octagam J1568 | 96365 | 96366 × 3-5 (4-6 hr typical) |
| Cytotoxic chemotherapy | Carboplatin J9045, Cisplatin J9060, Paclitaxel J9267 | 96413 | 96415 × n (each additional hour) |
| Chemo-class monoclonals | Herceptin J9355, Avastin J9035, Keytruda J9271 | 96413 | 96415 × n (Keytruda fixed 30-min = 96413 only) |
| IV push pre-medication | Dexamethasone J1100, ondansetron J2405, diphenhydramine J1200 | 96374 or 96375 | 96375 for each additional new drug push |
| Depot SC / IM hormonals | Lupron Depot J9217, Sandostatin LAR J2353, Eligard J9218 | 96372 (or 96402 if billed as chemo-hormonal) | None — single injection |
| Non-chemo SC / IM | Prolia J0897, Xgeva J0897, Hizentra J1559 | 96372 | None — single injection |
| Sequential chemo + biologic | Herceptin + Taxol same day; Avastin + FOLFOX same day | 96413 (chemo initial) | 96367 (biologic sequential), 96415 (chemo add'l hour) |
| Protective hydration (chemo) | Pre/post-cisplatin saline, methotrexate alkalinization | 96360 (separately billable) | 96361 × n (each additional hour) |
| Routine drug carrier hydration | Drug reconstituted in NS bag, routine flush | Bundled — do not bill 96360 | NCCI edit will reject |
Cross-references for the modifiers and J-code-specific billing pages that pair with these administration codes.
Remicade (infliximab, J1745) is a non-chemo biologic. Bill 96365 for the initial hour plus 96366 for the second hour. The "each additional hour" code 96366 requires at least 31 minutes beyond the first 60 minutes to be reported.
96413 (chemotherapy infusion, initial hour) is used for anti-neoplastic drugs and certain monoclonal antibodies with chemo-like toxicity, complex preparation, or extended observation requirements per the AMA CPT chemo administration definition. 96365 is for therapeutic, prophylactic, or diagnostic non-chemo infusions — biologics like Remicade, Ocrevus, Rituxan, Stelara IV, and IVIG. The classification follows the AMA definition, not the drug's primary indication.
No. 96360/96361 are bundled into the drug administration code when the IV fluid is just the vehicle for the drug or a routine flush. Hydration is separately billable only when there is documented medical necessity beyond drug delivery — for example, pre/post-cisplatin protective hydration, dehydration treatment, or hydration runs of >30 minutes that are distinct from the drug infusion. NCCI bundling edits reject 96360 when filed against the same encounter as a routine drug infusion.
The first hour is the first 16 to 90 minutes of the infusion. Any infusion lasting 16 minutes or longer qualifies as a billable initial infusion. The "each additional hour" add-on code (96366) requires that the additional time exceeds 30 minutes beyond the prior reported hour — that is, the infusion must run 91 minutes or longer to add a second unit of 96366, and so on for each additional hour.
Yes, but only one of them as the initial-service code per encounter. The AMA hierarchy is: chemotherapy > therapeutic infusion > hydration. If both a chemo drug and a non-chemo biologic are infused, the chemo administration code (96413) is the initial-service code; the non-chemo biologic is reported with 96367 (sequential infusion, additional drug) or 96375 (IV push) depending on how it was administered.
Generally no for the 96365-96379 IV/SC/IM family. Anatomic modifiers (RT/LT/E1-E4) attach to the procedure code that has anatomic specificity — for intravitreal injections that is the procedure code CPT 67028, and the J-code may also receive the side modifier per payer policy. The administration codes themselves report drug delivery time, not anatomic site.
JW applies to the J-code line only, never the administration code. The administration code (96365, 96413, etc.) reports the time spent infusing; JW reports the units of drug discarded from a single-dose container and attaches to the J-code on a separate claim line from the administered units.
The AMA revises CPT administration code descriptors and the NCCI manual updates bundling edits at least annually. CMS occasionally publishes MLN Matters articles clarifying time-counting and sequencing — the 2014 and 2018 clarifications on hydration bundling are still the operative guidance. We update each deep-dive page quarterly against the AMA CPT manual, the current-year NCCI Policy Manual for Medicare Services Chapter XI (Medicine), and the CMS Internet-Only Manual Pub 100-04 Chapter 12 §30.5 (services subject to the “incident to” rule, which governs the professional billing of these codes). Each page is reviewed by the CareCost editorial team on publication and on each material update; the full process is in the Editorial Policy.