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See a sample rate comparisonCPT 96371 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.
Sc Ther Infusion Reset Pump, Subcutaneous Infusion For Therapy Or Prophylaxis (Specify Substance Or Drug); Additional Pump Set-Up With Establishment Of New Subcutaneous Infusion Site(S) (List Separately In Addition To Code For Primary Procedure)
| 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 XS - Separate Structure |
| Complexity Level | Low |
| Medicare Fee Schedule | $56.45 national non-facility rate (2026) · View Medicare rates for 96371 |
| Medicaid Fee Schedule | $47.34 median of the 8 states in the free preview · View Medicaid rates for 96371 |
National average reimbursement for CPT 96371 by major payers:
$92.88
$88.08
$80.15
$114.42
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CPT 96371
5 of 25 sample ratesHigher to lower in this preview
Jaclyn Castoro
New York University
$192.54Published rateLaura Helfner
Ent And Allergy Associates, LLP
$105.87Published rateStacey Occomy
Franciscan Physician Network
$104.98Published ratePaul Bell
Ent And Allergy Associates, LLP
$70.61Published rateCraig Zalvan
$51.04Published rate
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See a sample payer proposalCPT 96371 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 96371 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 96371 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 |
|---|---|---|
| 96370-CPT | Low | Infusion Under The Skin, An Infusion Under The Skin Uses A Pump To Deliver A Fluid Or Medication Over A Period Of Several Hours. Infusion May Be Part Of A Therapy Preventive Measure Or A Part Of A Test. |
| 96371-CPT | Low | Sc Ther Infusion Reset Pump, Subcutaneous Infusion For Therapy Or Prophylaxis (Specify Substance Or Drug); Additional Pump Set-Up With Establishment Of New Subcutaneous Infusion Site(S) (List Separately In Addition To Code For Primary Procedure) |
| 96372-CPT | Low | Therpeutic, Prophylactic Or Diagnostic Injection {Specify Substance Or Drug}; Subcutaneous Or Intramuscular Nurse Pracitioner Rendering Service In Collaborati |
| 96416-CPT | Moderate | Chemo Prolong Infuse W Pump, Chemotherapy Administration Intravenous Infusion Technique Initiation Of Prolonged Chemotherapy Infusion More Than 8 Hours Requiring Use Of A Portable Or Implantable Pump |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96371. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96371 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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