How to bill CPT initial administration codes

Recent Blue Cross Blue Shield of Michigan audits of physician office infusion therapies revealed a need to clarify the correct way to bill Current Procedural Technology initial administration codes.

Only one initial administration code is billable. The CPT manual states: “When administering multiple infusions, injections, or combinations, only one ‘initial’ service code should be reported for a given date, unless protocol requires that two separate IV sites must be used.” The manual also states that “the ‘initial’ code that best describes the key or primary reason for the encounter should always be reported irrespective of the order in which the infusions or injections occur.”

It’s important to remember that the order in which the drug is administered doesn’t determine the initial code. For example, if the primary focus of the encounter is for the administration of chemotherapy, the sequential code should be applied for premeds given before the administration of that same chemotherapy.

For more information about initial code billing, refer to the CPT manual.

None of the information included herein is intended to be legal advice and as such it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.