No. The 96365 / 96523 edit carries modifier indicator 0: the port flush is bundled into the infusion and no modifier unbundles it. 96523 is payable only on a date when the port maintenance is the only service — a flush-only visit with no infusion, push, injection or E/M.
The 96523 / 96365 pair as it stands in the CMS PTP tables for 2026q3 (as of 2026-07-01), identical on the practitioner and hospital-outpatient tables:
96523 is bundled into 96365; no modifier makes it separately payable on the same date of service.
Column 1 96365 · column 2 96523 · edit effective January 2009.
Same edit, same direction: column 1 96365, column 2 96523, since January 2009. A UB-04 carrying 96365 and 96523 is adjudicated exactly as the CMS-1500 is.
Accessing and flushing an implanted venous access device is part of using it. CPT’s parenthetical says 96523 is not reported if an injection or infusion is provided the same day; NCCI goes further, pairing it with E/M codes as well, and enforces it with a modifier-indicator-0 edit against every administration code in the 96360–96379 range (the initial-code pairs since January 2009; the add-on codes such as 96361 and 96366 were added in April 2019). Indicator 0 is the hard version: unlike the indicator-1 edits on the other pages in this set, there is no XU, 59 or documentation that makes 96523 payable beside 96365.
The code exists for the maintenance visit — a patient between treatment cycles who comes in every four to twelve weeks for a heparin or saline flush to keep the port patent. On that date 96523 is the service, with a practitioner MUE of 1 (2 on the facility table), and the flush solution is not separately billed. If a nurse also gives an injection or the patient is seen by the physician, 96523 drops off and the other service is what the claim shows.
The worked claim above is deliberately short: it is the same iron infusion used elsewhere in this set, with no line for the port. That is the correct claim. A practice that adds 96523 to it will see the line deny, and a practice that appends a modifier to force it through is billing against an indicator-0 edit, which is the kind of pattern that surfaces in a comparative billing report.
Only a separate date. A flush-only visit — no infusion, push, injection, hydration or E/M — is the sole situation in which 96523 is reported, and it is then the only administration line on that claim.
| Code | Descriptor | Practitioner MUE / day | Facility MUE / day | Adjudication · rationale |
|---|---|---|---|---|
96523 | irrigation of an implanted venous access device (port flush) | 1 | 2 | MAI 3 · Clinical: Data |
96365 | therapeutic/prophylactic/diagnostic IV infusion, initial hour | 1 | 2 | MAI 3 · Clinical: Data |
96523 and 96365 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.
No hierarchy rule decides this one. 96523 is not an initial or add-on administration code; the 96365 / 96523 pairing is a straight NCCI bundling edit with modifier indicator 0, read in the verdict above, and CPT’s parenthetical under 96523 says the narrower version: not reported if an injection or infusion is provided on the same day.
CO-97 on 96523 whenever it lands with 96365 (or any 9636x/9637x code) on the same date. Do not append a modifier or appeal; remove the line. If the flush was the only service on a different date, bill 96523 alone on that date’s claim.
The median payer contract pays 120% of Medicare on 96365. 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. 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 |
1,762 payer×state medians for 96365 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 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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Not with Medicare’s edit: the 96365 / 96523 pair has modifier indicator 0, which bundles by date of service, not by encounter. Two visits on one date still produce one claim on which 96523 is included. A flush on a different date from the infusion is billable as 96523.
Into all of them. NCCI pairs 96523 as the column-2 code with 96360, 96361, 96365 through 96379 and the E/M codes, each at indicator 0 on the practitioner table (the hospital table pairs the E/M codes at indicator 1 and omits some add-on codes), so an injection-only or push-only visit also absorbs the flush. It is payable solely when port maintenance is the only service of the day.
That is a different service: 36593 (declotting by thrombolytic agent) describes it, and the alteplase (J2997) is a separate drug line. 36593 has its own NCCI relationships and is not the subject of the 96365 / 96523 edit; check it before assuming it bills with an infusion on the same day.