Injection and Infusion Services

Policy No: 109
Date of Origin: 05/01/2009
Section: Administrative
Last Reviewed: 09/01/2025
Last Revised: 09/01/2025
Approved: 09/11/2025
Effective: 10/01/2025
Policy Applies To: Group and Individual & Medicare Advantage

This policy applies only to physicians and other qualified health care professionals.

Injection and Infusion Services
An injection or medication administered subcutaneously, intramuscular or intravenously. Common Procedural Terminology (CPT®) identifies these services that are not intended to be reported by a physician when the service is provided in a facility setting.

Our health plan will not reimburse or permit a provider or other qualified health care professional to retain reimbursement for services that are not intended to be performed by a physician in a facility setting such as a hospital outpatient or emergency department. These physician charges will be denied as a provider write-off.

Ambulatory Surgical Centers (ASC), with a provider type of BZ, are excluded from this policy.

Examples of services defined as injection, infusion therapy and chemotherapy infusion that are not reportable by physicians and other qualified healthcare professionals for services provided in a facility setting include, but are not limited to:

Injection services codes: 96372-96377, and 96379.

Infusion therapy services codes: 96360, 96361, and 96365-96371.

Chemotherapy infusion services codes: 96401, 96402, 96405, 96406, 96409, 96411, and 96413.

CPT text states: These Injection and Infusion Services codes are not intended to be reported by the physician or other qualified health care professional in the facility setting.

Facility Place of Service codes are:

NCCI Policy Manual, current version, Chapter XI

Medicare Claims Processing Manual

Place of Service Code Set, Centers for Medicare & Medicaid Services (CMS)

Current Procedural Terminology (CPT®) Manual, American Medical Association. Current year version

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