Three facts pick the code: the route (IV, IM/SC or oral), the documented minutes (15 or less is a push, 16–90 is an infusion's first hour, 91+ earns an additional-hour add-on), and the drug class (chemotherapy or highly complex biologic versus everything else). An oral medication has no administration code at all — it is bundled into the office visit or not billed. Everything else lands in one of five families: hydration (96360/96361), non-chemo therapeutic infusion (96365/96366/96367/96368), IV push (96374/96375/96376), IM or SC injection (96372), or chemotherapy/complex-biologic administration (96401/96402/96409/96411/96413/96415/96417).
Read the table by route first, then by the documented minutes, then by drug class. Every code on this site's administration pages falls out of those three columns.
| Route | Documented time | Drug class | Code(s) |
|---|---|---|---|
| Oral | — | Any | No administration code — bundled into the E/M, or nothing billed if there is no E/M |
| IV push | 15 min or less (or no start/stop times charted, per MAC practice) | Non-chemo | 96374 (initial) · 96375 (each additional new drug) · 96376 (additional same drug, facility only) |
| IV push | 15 min or less (or no start/stop times charted, per MAC practice) | Chemo / highly complex biologic | 96409 (initial) · 96411 (each additional drug) |
| IV infusion | 16–90 min (initial hour) | Non-chemo | 96365 |
| IV infusion | Each additional hour from minute 91, with 31+ min into it | Non-chemo, same drug | 96366 |
| IV infusion | 16–90 min, after another drug already holds the initial code | Non-chemo, different drug | 96367 (sequential, once per additional drug) or 96368 (concurrent, once per encounter) |
| IV infusion | 16–90 min (initial hour) | Chemo / highly complex biologic | 96413 |
| IV infusion | Additional hour, or a second chemo drug sequentially | Chemo / highly complex biologic | 96415 (additional hour) · 96417 (sequential new chemo drug) |
| IV hydration | 31–90 min (initial hour); each additional hour from minute 91, with 31+ min into it; 30 min or less is not reported | Pre-packaged fluid/electrolytes, no drug | 96360 · 96361 |
| IM or SC injection | — | Non-chemo | 96372 |
| IM or SC injection | — | Chemo / highly complex biologic, non-hormonal | 96401 |
| IM or SC injection | — | Chemo / highly complex biologic, hormonal anti-neoplastic | 96402 |
The push-versus-infusion line is the one billers get backwards most often, and CMS defines it by the clock, not by the drug:
“For chemotherapy administration and therapeutic, prophylactic and diagnostic injections and infusions, an intravenous or intra-arterial push is defined as: 1.) an injection in which the healthcare professional is continuously present to administer the substance/drug and observe the patient; or 2.) an infusion of 15 minutes or less.” — CMS Pub. 100-04 Ch. 12 §30.5
The additional-hour threshold for an infusion works the same way in both the non-chemo and chemo families — a documented interval has to run more than 30 minutes past the prior hour before an add-on unit is earned:
“The physician may report the infusion code for ‘each additional hour’ only if the infusion interval is greater than 30 minutes beyond the 1 hour increment.” — CMS Pub. 100-04 Ch. 12 §30.5
Drug class is the third column, and it is a classification question, not a diagnosis question: an antiemetic or an anti-anemia drug given to a cancer patient is still coded as a non-chemo administration. “The administration of anti-anemia drugs and anti-emetic drugs by injection or infusion for cancer patients is not considered chemotherapy administration” (CMS Pub. 100-04 Ch. 12 §30.5). The reverse is also true — leuprolide for prostate cancer is chemotherapy-family regardless of the SC route, because CMS names it directly as a hormonal antineoplastic: “Drugs commonly considered to fall under the category of hormonal antineoplastics include leuprolide acetate and goserelin acetate” (same section), which is why the same drug given for endometriosis is 96372 and given for prostate cancer is 96402.
Whatever the table above says a drug's own administration is, only one of the day's administrations can be the encounter's initial service; everything else becomes an add-on to it.
“CPT codes 96360, 96365, 96374, 96409, and 96413 describe ‘initial’ service codes. 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.” — NCCI Policy Manual, Ch. XI §B.2
A physician office claim and a facility claim pick that one code differently. For physician (non-facility) reporting, CMS assigns it by the reason for the visit, not by the order drugs were given:
“The initial code is the code that best describes the key or primary reason for the encounter and should always be reported irrespective of the order in which the infusions or injections occur.” — CMS Pub. 100-04 Ch. 12 §30.5
A facility (hospital outpatient) claim instead works down a fixed hierarchy: chemotherapy or highly complex biologic administration outranks a non-chemo therapeutic, prophylactic or diagnostic administration, which outranks hydration; within a tier, an infusion outranks a push, which outranks an injection. Palmetto GBA, Article A53778, states the facility-instruction side of that ranking directly: infusion should be primary, injections and IV pushes next, and hydration therapy last. CPT's own introductory guidelines to the 96360-96549 series carry the chemo > therapeutic > hydration order on the drug-class side.
96376 is facility-only. CPT's own parenthetical under the code says so directly — “96376 may be reported by facilities only” — and CMS's Medically Unlikely Edit table confirms it from the payment side: the practitioner (physician office) MUE for 96376 is zero, while the facility MUE is 10. Billed with place-of-service 11 (physician office), there are no payable units. In an office, a repeat push of the same drug is included in 96374 rather than billed separately.
An oral medication has no administration code, plainly. None of the codes in the table above exist for a pill, capsule or oral solution — the "administration" is handing the patient the dose or watching them take it, and CPT has no code for that. Whatever evaluation supported giving the drug is billed as the E/M, if one is separately documented; the drug itself, if it is billed at all, goes on its own HCPCS line. This is also why the oral anti-cancer J-codes (J8501, J8510, J8530 and their neighbours) carry an MUE of zero on the practitioner table — not a low limit, a statement that a physician office does not bill them under Part B as administered drugs; the facility table keeps a real limit for them (J8501 = 57, J8530 = 60) because a hospital outpatient department can supply them.
This page is the picker; the family pages linked below are where the detail lives once the table has pointed to a code. Hydration has its own 31-minute floor and its own hydration-only-fluid rule; the therapeutic infusion family has the sequential-versus-concurrent question this table only summarizes; the push family has the 96376 facility restriction spelled out with denial examples; the injection code has the modifier-25-with-an-E/M question; and the chemotherapy family has the hormonal-versus-non-hormonal split and the additional-drug add-ons. Start there once the route, the minutes and the drug class have named a code.
96374 (or 96409 for chemotherapy), under MAC practice — not a CMS definition. Pub. 100-04 Ch. 12 §30.5 defines a push only by documented time (15 minutes or less); treating an administration with no charted start and stop times as a push by default is guidance MACs layer on top of that, and at least one (Palmetto GBA, Article A53778) will instead let you calculate the stop time from the volume, start time and rate. Either way, the fix going forward is charting the times, not picking the infusion code without them.
It depends on CPT's chemotherapy/highly complex biologic definition and, for Medicare, the drug's classification under Ch. 12 §30.5.D and the MAC's own chemotherapy-drug list; monoclonal antibodies and biologic response modifiers commonly fall in the 96401-96417 family even for non-cancer diagnoses. Anti-anemia and anti-emetic drugs given to a cancer patient stay in the non-chemo family regardless of the diagnosis.
Yes. An IV administration and an IM/SC injection are different routes with no overlap between them, so each is coded from its own row in the table — for example 96365 for the infused drug and 96372 for the injected one, both on the same claim.
No. None of the codes in the 96360-96549 series apply to an oral route. If a nurse or physician evaluates the patient in connection with starting an oral medication, that evaluation is billed as an E/M when it is significant and separately documented; the act of taking a pill has no administration code of its own.
Quoted passages are reproduced from the cited federal publications; everything else is our reading of them. The methodology by which we resolve source disagreements is described in the Methodology.