Are you being paid for Current Procedural Terminology (CPT®) code 96372 (administration of therapeutic injection) when it is billed on the same day as an office or outpatient evaluation and management (E/M) service (99201–99215)? Some practices report that they are paid for administration of the injection but not the E/M service. Others report that payment is made for the E/M service but not administration of the injection.

There may be several possible reasons for these denials.

Services should be reported based on CPT code guidelines. Note that in CPT 2012, in the instructions listed under the heading Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions (page 517 of the American Medical Association publication CPT 2012 Professional Edition), it states that when a significant, separately identifiable E/M service is performed in addition to injection and infusion codes (eg, 96372), modifier 25 should be appended to...

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