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See a sample rate comparisonCPT 96375 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.
Tx Pro Dx Inj New Drug Addon, Therapeutic Prophylactic Or Diagnostic Injection Specify Substance Or Drug Each Additional Sequential Intravenous Push Of A New Substance Drug 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 XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.70 national non-facility rate (2026) · View Medicare rates for 96375 |
| Medicaid Fee Schedule | $12.93 median of the 8 states in the free preview · View Medicaid rates for 96375 |
National average reimbursement for CPT 96375 by major payers:
$22.03
$22.72
$18.55
$36.92
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CPT 96375
5 of 25 sample ratesHigher to lower in this preview
Robert Shamberger
Dana-Farber Cancer Institute
$39.95Published rateRobb Friedman
Dana-Farber Cancer Institute
$39.95Published rateRainer Storb
Association Of University Physicians
$33.22Published rateArmando Villarreal Md PA
$18.88Published rateIheanyichukwu Aja-Onu
$12.98Published rate
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See a sample payer proposalCPT 96375 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 96375 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 96375 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 |
|---|---|---|
| 96374-CPT | Low | Injection Into Vein Or Iv, A Drug Is Given By Injection Into A Vein Or Through An Iv Over A Short Amount Of Time. Additional Injections May Be Given Of The Same Or A Different Drug. |
| 96375-CPT | Low | Tx Pro Dx Inj New Drug Addon, Therapeutic Prophylactic Or Diagnostic Injection Specify Substance Or Drug Each Additional Sequential Intravenous Push Of A New Substance Drug List Separately In Addition To Code For Primary Procedure |
| 96376-CPT | Low | Tx Pro Dx Inj Same Drug Adon, Therapeutic Prophylactic Or Diagnostic Injection Specify Substance Or Drug Each Additional Sequential Intravenous Push Of The Same Substance Drug Provided In A Facility List Separately In Addition To Code For Primary Procedure |
| 96409-CPT | Low | Injection Of Drug Into Vessel, One Or More Chemotherapy Agents Or Other Complex Drugs Injected Over Several Minutes Into A Blood Vessel. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96375 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 a medical procedure can vary significantly based on your insurance plan, location, provider, and specific details of the service. To get an accurate estimate for your specific situation, it's recommended to use tools that provide localized pricing information. You can use Payerprice's fee schedule lookup tool to search with a CPT code and your specific location to get a better understanding of potential costs.
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, allied health professionals, and other healthcare providers to report medical, surgical, and diagnostic services and procedures to entities such as health insurance companies. Each code corresponds to a specific service, allowing for standardized communication and billing across the healthcare system. Knowing the CPT code for a service can help you research its cost.
Healthcare costs vary due to a multitude of factors, including the type of service, geographic location, the specific healthcare provider (e.g., hospital vs. independent clinic), your insurance plan's negotiated rates, and whether the provider is in-network or out-of-network. Additionally, the complexity of the service and any associated facility fees or professional fees can contribute to cost differences.
Comparing prices for medical services can be challenging due to the complexity of healthcare billing. However, several resources are available. For specific, localized pricing information based on CPT codes, you can utilize Payerprice's fee schedule lookup tool. This tool allows you to search for costs based on specific CPT codes and your location, helping you understand potential charges. Your insurance provider might also offer a price transparency tool, or you can directly contact providers for estimates.
The provider's "charge" (also known as the list price or sticker price) is the amount a healthcare provider initially bills for a service. This is often significantly higher than what is actually paid. The "negotiated rate" is the discounted price that your health insurance plan has pre-arranged with in-network providers for specific services. As an insured patient, you typically pay a portion of this negotiated rate (e.g., deductible, co-insurance, co-pay), not the provider's full charge.
Estimating out-of-pocket costs involves understanding your health insurance plan's deductible, co-insurance, and co-pays, as well as the specific service's cost. First, identify the CPT code for the service if possible. Then, use a tool like Payerprice's fee schedule lookup tool with the CPT code and your location to get an idea of the service's price. Finally, factor in how much of your deductible you've met, your co-insurance percentage, and any applicable co-pays. It's always a good idea to contact your insurance company directly for the most accurate estimate based on your specific plan benefits.