CPT 96365

Across 1,288,254 services billed by 8,870 providers to 444,852 beneficiaries, Medicare allowed an average of $60.47 per service. That is 2.9 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

• 96372Injection of drug or substance under skin or into muscle$13.42
• 96375Injection of additional new drug or substance into vein$14.96
• 96367Infusion into a vein for therapy$27.64
• 96366Infusion into a vein for therapy$19.49
• 96361Infusion into a vein for hydration$12.46
• 96360Infusion into a vein for hydration$32.19
• 96374Injection of drug or substance into vein$36.97
• 96368Infusion into a vein for therapy$19.10
• 96377Application of on-body injector for under skin injection$18.64
• 96369Infusion into tissue for therapy or prevention$137.17
• 96370Infusion into tissue for therapy or prevention$15.36
• 96373Injection of drug or substance into artery$18.66

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

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