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See a sample rate comparisonCPT 96376 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 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
| 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 | View Medicare rates for 96376 |
| Medicaid Fee Schedule | $14.605 median of the 8 states in the free preview · View Medicaid rates for 96376 |
National average reimbursement for CPT 96376 by major payers:
$18.31
$14.96
$15.65
$29.91
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CPT 96376
5 of 25 sample ratesHigher to lower in this preview
Mark Meadors
Missouri Delta Medical Center
$14.06Published rateBrenna Maria Keller
Missouri Delta Medical Center
$14.06Published rateBrenna Maria Keller
Missouri Delta Medical Center
$12.77Published rateAndrianna Gonzalez
Missouri Delta Medical Center
$10.53Published rateRebecca Lenderman
Missouri Delta Medical Center
$9.57Published rate
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See a sample payer proposalCPT 96376 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 96376 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 96376 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 96376. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96376 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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