Not as two initial codes. With a chemotherapy infusion on the encounter (96413), each non-chemo drug pushed through the same access is 96375 — the add-on push — not 96374. 96374-XS (separate IV site) or 96374-XE (separate encounter) beside 96413 is for those two situations only.
The 96374 / 96413 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 96413 (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 96413 · column 2 96374 · edit effective January 2009.
Same edit, same direction: column 1 96413, column 2 96374, since January 2009. A UB-04 carrying 96413 and 96374 is adjudicated exactly as the CMS-1500 is.
Nearly every chemotherapy visit starts with antiemetic and steroid pushes. The pushes are separately payable; 96374 is the wrong code for them once 96413 is on the encounter, because there is one initial service and it is the chemotherapy — the reason for the visit in physician reporting, and the top of CPT’s hierarchy in facility reporting. Each non-chemo substance pushed is one unit of 96375 (practitioner MUE 6 per date of service), on the same claim as the 96413 that makes it payable.
The 96413 / 96374 edit (column 2 = 96374, modifier indicator 1, since January 2009) is what turns the wrong code into a denial. Claims with 96413 + 96374 lose the push; claims with 96413 + 96375 pay both lines with no modifier. XS or XE on 96374 is reserved for the genuinely separate service — XS for a second IV access started because a pushed drug could not share the chemotherapy line, XE for a return encounter later that date.
The example keeps the hours honest: 30 minutes of gemcitabine is 96413 alone (an infusion is 16 minutes or more, and an additional hour needs more than 30 minutes into the second hour), and the two pushes add nothing to infusion time. Pushes are administrations of 15 minutes or less; a premed that dripped for 20 minutes would instead be 96367, the sequential infusion of a new drug, still without an edit against 96413.
A second IV access site started because a pushed drug was incompatible with the chemotherapy line, or a separate encounter on the date — then 96374-XS or 96374-XE with 96413. Pushing premeds through the chemotherapy line before the bag is hung is sequential and is 96375.
| Code | Descriptor | Practitioner MUE / day | Facility MUE / day | Adjudication · rationale |
|---|---|---|---|---|
96374 | therapeutic IV push, single or initial drug | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96413 | chemotherapy or highly complex biologic IV infusion, initial hour | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96374 and 96413 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 96374 / 96413 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 with 96413. Rebill the premeds as 96375 units (one per substance, no modifier) when they went through the same access on one encounter; keep 96374-XS or 96374-XE for a documented separate site or separate encounter.
The median payer contract pays 139–140% of Medicare on 96374, 96413, 96375. On 96374 the highest payer median is Blue Shield of California’s $186.05 and the lowest BCBS Arizona’s $25.13, against Medicare’s $37.74; 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 |
|---|---|---|---|---|
96374 | $37.74 | $52.75 (140%) | $47.72–$62.12 | 37 |
96413 | $133.27 | $187.00 (140%) | $170.46–$217.49 | 36 |
96375 | $15.70 | $21.78 (139%) | $20.08–$26.24 | 37 |
5,232 payer×state medians for 96374, 96413, 96375 from 37 payers’ Transparency-in-Coverage files (2026-Q2-06); Medicare = national non-facility PFS.
This claim priced by your payer — Gemcitabine’s rate on the drug line, 96374 and 96413 and 96375 at the payer’s contracted amount, the payer’s policy on Gemcitabine (prior auth, covered diagnoses), and the patient’s share — is the same claim in your free account.
Price this claim for your payer — start free →
Free 30-day trial, no card. The claim above opens in Claim Check with the drug, dose, setting and your payer already filled in.
Yes, one unit per different non-chemo substance, within the practitioner MUE of 6 per date of service, plus a J-code line for each drug. A repeat push of the same drug does not add a unit in the office; 96376 for that is a facility-only code.
Then the chemotherapy push is the initial service, 96409, and the non-chemo premeds are still 96375. 96374 is not used on that encounter either; the 96409 / 96374 relationship works the same way as 96413 / 96374, with the push family’s initial code reserved for the highest-ranking drug.
When a non-chemo premed was infused rather than pushed — documented at 16 minutes or more through the same access, sequentially. Then it is 96367 (up to one hour) with 96413 as the initial code, and there is no PTP edit between 96413 and 96367.