Yes — a different drug given IM or SC is a separate service from an IV push, and both are reported. The 96374 / 96372 edit (column 2 = 96372, modifier indicator 1) means the injection line carries XU or 59. What does not exist is a “96372 for an IV push”: a second drug pushed IV is 96375.
The 96372 / 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:
96372 (column 2) denies as included in 96374 (column 1) unless the 96372 line carries a distinct-service modifier — XU or 59 — and the record supports a distinct service.
Column 1 96374 · column 2 96372 · edit effective January 2009.
Same edit, same direction: column 1 96374, column 2 96372, since January 2009. A UB-04 carrying 96374 and 96372 is adjudicated exactly as the CMS-1500 is.
Migraine cocktails, nausea protocols and urgent-care visits put a pushed drug and an injected drug on the same claim, and the two code families were built for exactly this. 96374 describes the IV route and 96372 the IM or SC route; because the routes differ, neither is an add-on of the other and each is reported at full value. The MUE for 96372 in the office is 4 per date of service and for 96374 it is 1 (one initial IV push per encounter), so a second IM drug is another unit of 96372, while a second IV drug is 96375, never a second 96374.
NCCI still pairs them. The 96374 / 96372 edit, modifier indicator 1 since January 2009, will deny 96372 as bundled unless the line says the injection was a distinct service — which an IM injection of a different drug is, by definition. XU is the precise modifier (unusual non-overlapping service); 59 is accepted where a payer has not adopted the X modifiers. The modifier belongs on 96372, the column-2 code.
The wrong version of this claim reads: ondansetron pushed, ketorolac pushed through the same line, billed 96374 + 96372-59. The second push is 96375 with no edit against 96374 and no modifier needed, and calling it 96372 misstates the route on a federal claim. The route in the MAR is the only thing that decides between 96372 and 96375.
The route decides it; there is no separate-encounter test. The test is route and substance: a different drug, not delivered through the IV access, with its own order, dose and injection site recorded.
| Code | Descriptor | Practitioner MUE / day | Facility MUE / day | Adjudication · rationale |
|---|---|---|---|---|
96372 | therapeutic, prophylactic or diagnostic injection, SC or IM | 4 | 5 | MAI 3 · Clinical: Data |
96374 | therapeutic IV push, single or initial drug | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96372 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 96372 / 96374 answer rests on H10 in the claim builder’s rule set (source: CPT 2026 hydration / therapeutic infusion guidelines · CMS Pub 100-04 ch. 12 §30.5), the rule it applies when it places a line by route:
…a subcutaneous or intramuscular therapeutic injection reports 96372 (96401 chemo/biologic)… Full text of H10
Related hierarchy rules for this claim: H5 (CPT 2026 hydration / therapeutic infusion guidelines).
CO-97 on 96372 billed bare with 96374. Append XU to 96372 and resubmit with the MAR. If the “injection” went into the IV line, replace 96372 with 96375 and remove the modifier.
The median payer contract pays 126–140% of Medicare on 96372, 96374. On 96372 the highest payer median is Blue Shield of California’s $67.48 and the lowest BCBS Arizona’s $10.96, against Medicare’s $15.36; Blue Shield of California is highest on 2 of the 2 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 |
|---|---|---|---|---|
96372 | $15.36 | $19.31 (126%) | $17.22–$24.16 | 37 |
96374 | $37.74 | $52.75 (140%) | $47.72–$62.12 | 37 |
3,526 payer×state medians for 96372, 96374 from 37 payers’ Transparency-in-Coverage files (2026-Q2-06); Medicare = national non-facility PFS.
This claim priced by your payer — Zofran’s rate on the drug line, 96372 and 96374 at the payer’s contracted amount, the payer’s policy on Zofran (prior auth, covered diagnoses), and the patient’s share — is the same claim in your free account.
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Yes: two different drugs by the IM route are 96372 × 2 (practitioner MUE 4 per day), each with XU against the 96374, plus 96374 × 1 for the push. Three J-code lines carry the drugs. Two injections of the same drug at one sitting stay one unit.
No — 25 goes on the E/M code, never on 96372 or 96374. If the visit had a significant, separately identifiable evaluation, the office-visit code carries 25 and both administration codes bill as described here; 96372 still needs XU against 96374.
Same edit (the 96374 / 96372 pair has modifier indicator 1 on the hospital PTP table too), and the facility MUE for 96372 is 5 rather than 4. The facility reports the administration codes on the UB-04; the physician does not report them for a facility encounter.