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See a sample rate comparisonCPT 96365 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Iv Infusion, An Iv Infusion Delivers A Fluid Or Medication Over One Hour. Infusion May Be Part Of A Therapy Preventive Measure Or A Part Of A Test.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $67.14 national non-facility rate (2026) · View Medicare rates for 96365 |
| Medicaid Fee Schedule | $52.785 median of the 8 states in the free preview · View Medicaid rates for 96365 |
National average reimbursement for CPT 96365 by major payers:
$92.11
$90.89
$92.02
$114.15
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CPT 96365
5 of 25 sample ratesHigher to lower in this preview
Hans Gerdes
Memorial Gastroenterology Group
$345.98Published rateMichael Blechman
Union Square Gastroenterology PC
$155.17Published rateNelson Chuang
Frederick Gastroenterology, Inc.
$107.26Published rateShabbir Jamali
Gastroenterology Diagnostic Center
$72.22Published rateSwapnil Munsaf
Western New York Medical Practice PC
$56.49Published rate
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See a sample payer proposalCPT 96365 vs. Other Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Codes
The CPT 96365 code is part of the Medicine Services and Procedures services used for Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96365 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 96360-CPT | Low | Fluids Given By Iv To Hydrate, Saline Or Other Fluids Given By Iv. The Fluids Rehydrate The Body After The Normal Fluid Level Has Dropped From Vomiting Diarrhea A High Fever Or Other Symptom. |
| 96361-CPT | Low | Fluids Given By Iv To Hydrate, Saline Or Other Fluids Given By Iv. The Fluids Rehydrate The Body After The Normal Fluid Level Has Dropped From Vomiting Diarrhea A High Fever Or Other Symptom. |
| 96365-CPT | Low | Iv Infusion, An Iv Infusion Delivers A Fluid Or Medication Over One Hour. Infusion May Be Part Of A Therapy Preventive Measure Or A Part Of A Test. |
| 96366-CPT | Low | Ther Proph Diag Iv Inf Addon, Intravenous Infusion For Therapy Prophylaxis Or Diagnosis Specify Substance Or Drug Each Additional Hour List Separately In Addition To Code For Primary Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96365. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96365 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
The cost of medical procedures can vary significantly based on the provider, your geographic location, and your insurance plan. To get a precise estimate tailored to your situation, including specific CPT codes for the procedure and your location, you can utilize tools like Payerprice. They offer a fee schedule lookup tool that allows users to search for costs using CPT codes and specific locations, helping you understand potential expenses before a service.
For looking up prices associated with a specific CPT (Current Procedural Terminology) code based on your location, Payerprice provides a convenient fee schedule lookup tool. You can input the CPT code and your geographic area to find relevant pricing information, which is invaluable for understanding potential healthcare costs.
Yes, to compare prices for various healthcare services based on specific CPT codes and your location, Payerprice offers a valuable fee schedule lookup tool. This allows you to search for and compare potential costs for procedures in your area, enabling you to make more informed decisions about your healthcare.
CPT (Current Procedural Terminology) codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding medical costs because insurers and providers use these codes to process claims, determine reimbursement rates, and establish prices. Knowing the CPT code for a service is the first step in accurately estimating its cost, and tools like Payerprice can help you look up prices associated with these codes based on your specific location.
Estimating your out-of-pocket expenses requires understanding both the cost of the service and your insurance coverage. While you should always contact your insurance provider directly for details on your specific plan's benefits, deductibles, and co-pays, you can estimate the initial cost of a service using Payerprice's fee schedule lookup tool. By searching with the relevant CPT code and your location, you can get a clearer picture of the potential charges, which then helps you better anticipate your share after insurance.