96367 reports a new drug infused after the previous one finished, through the same IV access, for up to an hour. You report it once for each additional drug.
96368 reports a drug infused at the same time as another, through the same IV access. It is not timed, and you report it once for the whole encounter — once, no matter how many drugs ran together or how long they ran.
Both are add-on codes. Neither can stand alone on a claim, and neither can be the initial service. Something else in the encounter has to carry the initial code first.
| Code | Descriptor | Status | How units are counted |
|---|---|---|---|
| 96367 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; additional sequential infusion of a new drug or substance, up to 1 hour | Add-on (ZZZ global). Requires a primary service. | Once per additional drug. A second and third sequential drug are two units. |
| 96368 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; concurrent infusion | Add-on (ZZZ global). Requires a primary service. | Once per encounter. Not per drug, not per hour. |
The word doing the work in 96367 is new. If the same drug simply keeps running past the hour, that is not a sequential infusion — it is additional time on the drug you already reported, which is 96366. A sequential infusion requires a different substance.
The word doing the work in 96368 is concurrent. Two bags hanging at once, with overlapping administration times documented in the record, running either through the same venous access site or through two separate lumens of the same multi-lumen catheter — both count as concurrent. What does not count is two genuinely separate access sites, such as a second peripheral IV in the other arm. That is two access sites, and 96368 does not describe it.
| Code | Non-facility | Facility | Total RVU |
|---|---|---|---|
| 96367 — additional sequential infusion | $29.73 | $29.73 | 0.89 |
| 96368 — concurrent infusion | $20.71 | $20.71 | 0.62 |
The economics are worth noticing before you code. A concurrent infusion pays once for the encounter no matter how many drugs ran together. Three drugs infused sequentially generate two units of 96367 — roughly $59 — while the same three drugs hung concurrently generate a single 96368 at $20.71. The codes are not interchangeable and you do not get to pick the better-paying one; the clinical administration decides it, and the record has to support what you billed.
Neither 96367 nor 96368 makes sense until you have settled which service is the initial one, because both are add-ons to it. For a single IV access site, an encounter gets exactly one initial code. Not one per drug — one per encounter.
Everything that is not the initial service becomes an add-on: 96367 if it ran sequentially, 96368 if it ran concurrently, 96366 if it is more time on a drug already reported.
This is why the initial code is so often not the first drug on the MAR. A patient who gets an anti-emetic at 09:00 and carboplatin at 09:40 does not get 96365 for the anti-emetic. The carboplatin is chemotherapy, so 96413 is the initial code, and the earlier anti-emetic drops to a sequential add-on.
Two drugs in one bag is not a concurrent infusion. If multiple substances are admixed into a single bag and hung once, that is one infusion, not two running side by side. Report a single administration — the drugs themselves are still reported separately by their own HCPCS codes, but there is no 96368 and no 96367, because only one infusion was administered.
The documentation test. Sequential versus concurrent is decided entirely by start and stop times, and no other part of the record can substitute for them. If the nurse charted “drug B given with drug A” but recorded only one set of times, there is nothing in the chart that distinguishes 96367 from 96368 — and on audit that ambiguity is resolved against the practice. Overlapping times must be visible as times.
This is the single most expensive misunderstanding in this pair, and it runs in both directions.
Medicare (all MACs). Follows AMA CPT sequencing and the NCCI Policy Manual. One initial code per encounter per access site; add-ons deny without the primary. MACs apply Medically Unlikely Edits to both codes — 96368 in particular is edited tightly, consistent with its once-per-encounter instruction.
Commercial payers. Most adopt CPT sequencing directly, but a number apply their own unit caps on 96367 and will request the administration record when three or more units appear on one claim. Overlapping start and stop times are the evidence that decides a 96368 review.
All payers. The distinguishing documentation is identical everywhere: drug name, route, and a start and stop time for each administration. Everything on this page follows from those timestamps.
| What comes back | Why | The fix |
|---|---|---|
| Add-on billed without a primary procedure | 96367 or 96368 submitted with no initial administration code on the claim, or the primary was denied and took the add-on with it | Confirm an initial code is present and payable for the encounter. If the primary denied, resolve that first — the add-on cannot be appealed on its own. |
| Service bundled or not separately payable | Two initial codes on one encounter. The second initial code should have been an add-on. | Rebill with a single initial code chosen by the hierarchy, and the other administration as 96367 or 96368. |
| Missing or incomplete information | No start and stop times, so sequential versus concurrent cannot be established | Submit the administration record with times for every drug. This is the top cause of denial in this family and it is a documentation fix, not a coding one. |
| Units exceed the allowed maximum | Most often 96368 reported more than once per encounter | Correct to a single unit of 96368. If several drugs ran together, that is still one unit — the code covers the concurrent episode, not each drug. |
| Sequential add-on denied as duplicate | 96367 reported for additional time on the same drug rather than for a new substance | Rebill the additional time as 96366 (or 96415 under a chemo initial). Reserve 96367 for a genuinely different drug. |
No. Both are add-on codes and require a primary service in the same encounter. An add-on submitted alone denies for a missing primary procedure, and it cannot be appealed independently — the underlying initial code has to be corrected first.
One. 96368 is reported once per encounter regardless of how many drugs ran concurrently or how long they ran. There is no additional-hour add-on for concurrent infusion, and reporting multiple units is a routine audit finding.
96367 covers up to the first hour of the sequential drug. Additional hours of that same drug are reported with 96366, each additional hour — not with more units of 96367. The usual CPT convention applies to those hours: an extra 31 minutes or more earns a unit, 30 minutes or less does not. A second unit of 96367 means a second additional drug, not more time.
It depends on what “different sites” means. Two separate lumens of the same multi-lumen catheter are concurrent — report 96368. Two genuinely separate access sites, such as a second peripheral IV in the other arm, are not; check payer guidance before reporting a second initial code, and document both sites clearly.
No. Substances admixed into a single bag and hung once are a single infusion. Report one administration code — neither 96367 nor 96368 applies, because only one infusion was given. The individual drugs are still billed separately under their own HCPCS codes.
No. Hydration given concurrently with a therapeutic or chemotherapeutic infusion is not separately reportable — not as 96360, not as 96361, and not as 96368. Hydration is only separately billable when it is given on its own and meets the minimum time.
Because the hierarchy is not chronological. Chemotherapy administration outranks therapeutic, prophylactic, and diagnostic administration regardless of the order the drugs were given. The chemo carries the initial code and the earlier pre-medication becomes 96367 if it was infused, or 96375 if it was pushed.
96417, if it is genuinely chemotherapy and given sequentially under a chemo initial code. 96367 is the therapeutic-family sequential add-on. The classification follows the AMA chemotherapy administration definition, not whether the patient is an oncology patient — a rescue agent or supportive drug in a chemo regimen is usually therapeutic, and takes 96367.
No. An administration of 15 minutes or less is an IV push, not an infusion. A sequential push of a different drug is 96375. The 16-minute floor applies to the additional drug on its own terms, not to the encounter as a whole.