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How and When to Use the 96372 CPT Code

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Understanding how and when to use the 96372 CPT code can help you optimize your billing process. When it comes to mental and behavioral health billing, using codes to correctly bill for the services you deliver to your patients is a crucial component to getting paid on time. Every service has a corresponding billing code and these codes need to be applied accurately, every single time if providers will receive more on-time and in-full reimbursements from insurance payers. The reality is that insurance payers will look for every opportunity to deny your claim and errors in billing codes are a huge reason for them to do this. 

With all of this in mind, how and when should providers use the 96372 CPT code? 

Breaking Down CPT Code 96372

The  96372 CPT code is is a procedural code defined as therapeutic, prophylactic, and diagnostic substance by subcutaneous or intramuscular injections and infusions. . While this code is not often used in the mental and behavioral health setting, there are certain specialties that do use it. For example, outpatient behavioral health and substance use disorder facilities may use this code in their treatment process. Most commonly, this is used more specifically for the extended-release naltrexone injection during substance abuse treatment. 

The 96372 CPT code is to be billed for each injection performed on a patient. Modifier 59 should be used when the injection is a separate service from other treatments. 

Subsequent codes related to this code include: 

96373 –  therapeutic, prophylactic, and diagnostic substance by intra-arterial injections and infusions

96374 – therapeutic, prophylactic, and diagnostic substance by IV-push injection of a single or initial substance or drug

96375 – therapeutic, prophylactic, and diagnostic substance by IV-push injection of an additional or subsequent substance or drug

96376 – therapeutic, prophylactic, and diagnostic substance injection of an additional or subsequent substance or drug, using an on-body injector 

 Requirements for Reimbursement:

  1. Direct Physician Supervision – must be done under the direct supervision of an MD. In this setting that would be the prescribing psychiatrist. 
  2. Report Per Injection – code must be reported per injection, not per substance. This means that if there is more than one substance in the injection, it is only billed once. 
  3. Records Must Support Use – Patient history and treatment plan must support the rendering of services. 

Common Causes for Denials:

One of the most common reasons that providers encounter denied claims is that there is an error in their coding process. Claims must be coded accurately if providers wish to be reimbursed on time. Applying the right code at the right time is a huge part of this. After all, insurance companies will always search for reasons to deny your claim and save their own money. So what are the best methods for minimizing coding errors? 

Billing Accurately for This Code with Billing Software:

The most effective method for reducing errors in your claim process is to implement billing software with a good reputation. Software design for your specialty can help you accurately apply codes, pinpoint frequent errors, files claims on time and so much more. Some of the most useful features of quality billing software include: 

  1. Electronic Claim Processing: The manual filing of claims can quickly lead to an influx of errors. Electronic claim processing with software designed for mental and behavioral health providers is the fastest way to streamline your claim process and increase accuracy in your coding. This includes the 96372 CPT code. 
  2. Claim Status: Some software also comes equipped with claim tracking so you always know the status of your claim and can know when it is approved or denied. If it is denied, this allows you to be on top of resubmittal requirements. 
  3. Process Payments: does your client have a bill they need to pay? Quality billing software comes integrated with easy payment processing so they can pay their bill directly through your account. 

With quality billing software, the frustrations of behavioral health billing start to decline and providers gain back much-needed time. With CPT codes that feel impossible to memorize and billing requirements that are always changing, providers need the best tools to help them through each step of the process. 

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