Not as two initial codes. On one encounter the infusion is the initial service (96365) and a push of another drug through the same access is 96375, the add-on push. 96374 joins 96365 only at a separate IV site (XS) or a separate encounter (XE).
The 96365 / 96374 pair as it stands in the CMS PTP tables for 2026q3 (as of 2026-07-01), identical on the practitioner and hospital-outpatient tables:
96374 (column 2) denies as included in 96365 (column 1) unless the 96374 line carries a distinct-service modifier — XS for a separate access site, XE for a separate encounter, or 59 — and the record supports a distinct service.
Column 1 96365 · column 2 96374 · edit effective January 2009.
Same edit, same direction: column 1 96365, column 2 96374, since January 2009. A UB-04 carrying 96365 and 96374 is adjudicated exactly as the CMS-1500 is.
Premedication is where this pair lives: diphenhydramine, famotidine, ondansetron or a steroid pushed before a biologic. Each of those is a real, separately reportable administration — the mistake is the code family. 96374 is an initial-service code, and CPT allows one initial per encounter; with an infusion on the claim the push has to be reported as 96375 (each additional sequential new drug). The payment difference is real but the code is not optional.
The 96365 / 96374 edit (column 2 = 96374, modifier indicator 1, since January 2009) is the enforcement. Bill both bare and the 96374 denies as included. The modifier route exists for the day the push genuinely could not share the access — a second IV started for a drug incompatible with the line — or for a second encounter on the same date, and in both cases the chart has to say so.
Two further checks on the example: a push is a documented administration of 15 minutes or less, so a “push” that ran for 20 minutes is an infusion and would be 96367 (sequential infusion) instead; and the practitioner MUE for 96375 is 6 per day, so several premeds pushed one after another are units of 96375, not repeated 96374s.
A second peripheral line or a port accessed separately because the pushed drug was incompatible with the infusion, or a second encounter on the date. That supports 96374-XS or 96374-XE with 96365. Pushing through the Y-site of the running infusion never does.
| Code | Descriptor | Practitioner MUE / day | Facility MUE / day | Adjudication · rationale |
|---|---|---|---|---|
96365 | therapeutic/prophylactic/diagnostic IV infusion, initial hour | 1 | 2 | MAI 3 · Clinical: Data |
96374 | therapeutic IV push, single or initial drug | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96365 and 96374 are MAI 3: units are summed across the date of service, and a documented medical-necessity appeal can pay units above the limit. Other codes: MUE lookup.
The 96365 / 96374 answer rests on H1 in the claim builder’s rule set (source: NCCI Policy Manual 2026 ch. XI §B.2), the rule it applies when it places the initial-service line:
…For a patient encounter, only one "initial" service code may be reported unless it is medically reasonable and necessary that the drug or substance administrations occur at separate intravenous access sites.… Full text of H1
Related hierarchy rules for this claim: H5 (CPT 2026 hydration / therapeutic infusion guidelines) and H10 (CPT 2026 hydration / therapeutic infusion guidelines · CMS Pub 100-04 ch. 12 §30.5).
CO-97 on 96374 billed with 96365. Rebill the push as 96375 (no modifier) when it went through the same access on one encounter; append XS (separate site) or XE (separate encounter) to 96374 only when the record shows one.
The median payer contract pays 120–140% of Medicare on 96365, 96374, 96375. On 96365 the highest payer median is Blue Shield of California’s $268.22 and the lowest BCBS Arizona’s $41.15, against Medicare’s $67.14; Blue Shield of California is highest on 3 of the 3 lines. Pick a state below for each payer’s own number where you bill.
| Code | Medicare (PFS, office) | Median payer contract | Middle half of payer medians | Payers |
|---|---|---|---|---|
96365 | $67.14 | $80.58 (120%) | $76.35–$94.57 | 37 |
96374 | $37.74 | $52.75 (140%) | $47.72–$62.12 | 37 |
96375 | $15.70 | $21.78 (139%) | $20.08–$26.24 | 37 |
5,285 payer×state medians for 96365, 96374, 96375 from 37 payers’ Transparency-in-Coverage files (2026-Q2-06); Medicare = national non-facility PFS.
This claim priced by your payer — Venofer’s rate on the drug line, 96365 and 96374 and 96375 at the payer’s contracted amount, the payer’s policy on Venofer (prior auth, covered diagnoses), and the patient’s share — is the same claim in your free account.
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No. Order of administration does not pick the initial code. For physician reporting, CPT assigns the initial code to the primary reason for the encounter — the infusion the patient came for; facility reporting applies CPT’s hierarchy (chemotherapy over therapeutic infusion over push over hydration) and lands on the same code. The infusion is the initial service (96365) whatever the clock says, so the push is 96375.
One line of 96375 with 3 units (the practitioner MUE for 96375 is 6 per date of service), plus three J-code lines for the drugs. Each is a new substance, so each counts; a second push of the same drug does not add a unit in the office (96376 is a facility-only code).
Yes; the pair carries the same modifier-indicator-1 edit on the hospital (facility) PTP table. The facility MUE values also differ from the office ones for some codes on this claim, which is why the worked visit above states the setting.