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96413 IV with 96372 SQ Medicare

Rene Posted Mon 29th of July, 2019 09:46:27 AM
When billing 96372 with 96413 for medicare, what would be the appropriate modifier for 96372? Since Medicare does not accept 59. Would it be XU? I have not used modifier XU before that's why I am not sure about this. Thanks in advance.
SuperCoder Answered Tue 30th of July, 2019 10:10:04 AM



Both CPT codes 96413 and 96372 are drug administration codes. CPT 96413 is used for intravenous infusion of chemotherapeutic drug. On the other hand, CPT 96372 is used for administration of drug through subcutaneous or intramuscular. As per CCI edits, 96372 required modifier to override relationship when billing with 96413. If medicare does not accepting 59, then bill CPT 96372 with modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to override the edit.


Hope this helps.



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