CPT^® 96425, Under Intra-Arterial Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration

The Current Procedural Terminology (CPT^®) code 96425 as maintained by American Medical Association, is a medical procedural code under the range - Intra-Arterial Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration.

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Summary

In this procedure, the provider administers the chemotherapy drug into an artery using an infusion technique. Infusion takes place through an implantable or portable pump and lasts more than 8 hours. Use this code for infusion initiation.

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Have a question about CPT Code 96425 ? Start a discussion here

Office visit or injection?

[QUOTE="AprilSueMadison, post: 476238, member: 118514"] If doctor is in the building and doesn't see the patient but wrote an order for the injection two months ago (last visit) - the nurse provided t... [ Read More ]

cpt 96402

Medicare says, "Codes 96401-96402, 96409-96425, 96521-96523 are not intended to be reported by the individual physician or other qualified health care professional in the facility setting. " I am con... [ Read More ]

Inpatient pediatric consults

[QUOTE="tammym7797, post: 458998, member: 611619"] Do pediatric consults (inpatient) get paid by most insurance companies? What if a pediatrician is consulted to hospital and only monitors IV antibio... [ Read More ]

Billing for chemotherapy/infusion regimen education

There is not. If there is sufficient documentation of a separately-identifiable E&M visit on the same day as the chemo administration, you can bill both. However, there is an element of patient educ... [ Read More ]

Auditor states drug ordered as IV over 2 minutes must have a doc stop time?

When its just an IV PUSH there does not need to be a stop time. If it truly was an IV drug hung for say 20 minutes yes there would need to be start and stop times but the PUSH IV drugs do not need t... [ Read More ]

Rocephin w/ Admin w/ 99211...yes or no?

You can refer them to the NCCI policy manual, Chapter XI, which states: "[I]The drug and chemotherapy administration CPT codes 96360-96375 and 96401-96425 have been valued to include the work and pra... [ Read More ]

Facility E/M Straightforward 99281

[QUOTE="fami, post: 431885, member: 18765"]Hi, Question; do you bill 99211- with chemo/ infusion service on the same day at the facility clinic? Any link to CMS or compliance you have to share? Tha... [ Read More ]

Is this separately billable?

Below from the AMA/CPT, it is not intended in a facility setting that a physician would report codes such as 96360-96379. They believe an IM injection would typically be ordered by the physician and p... [ Read More ]

POS for 96542

What is the correct POS for CPT code 96542 CPT BOOK States: CPT codes 96360-96379, 96401-96425, and 96521-96523 are reportable by physicians for services performed in physicians? offices. These drug ... [ Read More ]

lidocaine bolus

The below addresses your question regarding an E/M code being reported. "If a significant, separately identifiable office or other outpatient Evaluation and Management service is performed, the appr... [ Read More ]

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