Administration of a drug by injection under the skin or into a muscle for treatment, prevention, or diagnosis, with the drug itself billed separately.
- Medicare
- $15.36
- Work RVU
- 0.17
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 4 cited references ↓
- Drug name, dose, route (IM or SC), and J-code with units
- Injection site (for example right gluteus, abdomen)
- Lot number and expiration date
- Ordering provider and reason for the injection
- Supervising provider present for incident-to billing
- Patient response or observation period if applicable
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 4 cited references ↓
96372 is the administration fee for a subcutaneous or intramuscular injection. Ortho offices bill it constantly: IM ketorolac for acute pain, IM methylprednisolone or triamcinolone for a flare, and subcutaneous denosumab for osteoporosis. The drug goes on the claim with its own J-code and units.
It is not the code for a joint, bursa, tendon sheath, or trigger point injection. Those have their own procedure codes (20550 to 20611 range) that include the administration. Billing 96372 for a knee injection is a common and avoidable error.
With an E/M visit, put modifier 25 on the E/M when the visit is significant and separate from the decision to inject. Medicare does not pay 99211 on top of 96372, so a nurse-only visit for a shot goes out as 96372 alone. In a facility setting, the physician does not bill 96372. For incident-to billing in the office, the supervising provider must be in the suite. Record the site, route, drug, dose, and lot number.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.17) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.46) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.17 |
| Practice expense RVU | 0.28 |
| Malpractice RVU | 0.01 |
| Total RVU | 0.46 |
| Medicare national rate | $15.36 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $15.36 |
HOPD (APC 5692) Hospital outpatient department | $73.56 |
Common denial reasons
The recurring reasons claims for CPT 96372 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed with a joint or soft tissue injection code for the same shot
- Billed with 99211 on the same day
- E/M billed without modifier 25
- Drug J-code missing or units do not match dose
- Billed by the physician in a facility setting
- Denosumab or other drug lacks prior authorization
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 4 cited references ↓
01Can I bill 96372 for a cortisone injection into the knee?
02Can 96372 and 99211 be billed together?
03Does Prolia use 96372?
04Do I need modifier 25 when I bill 96372 with an office visit?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the drug, dose, route, and site in the note and keeps the separate exam findings distinct, which supports both 96372 and a modifier 25 visit.
See how Mira captures CPT 96372 documentation