CPT code 96365: IV drug infusion, initial, first hour2026 Medicare rate & RVUs

Medicare pays $67.14 for 96365 nationally in the office. Local office rates run $58.20–$93.27.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96365 covers

This code covers the initial hour of a therapeutic, preventive, or diagnostic IV drug infusion, such as an IV antibiotic or iron infusion lasting more than 15 minutes. Infusion nurses or other clinical staff commonly perform it in physician offices and infusion suites. IV access, routine flushes, tubing, and monitoring are included in the administration service. Staff document the drug, dose, route, and infusion start and stop times.

Select the initial administration code using the drug administration hierarchy, not simply the drug given first or the visit’s chief reason. Usually, one initial administration service is reported per encounter; a protocol requiring distinct IV sites may support another. Report 96366 when the same infusion reaches 91 minutes, 96367 for a subsequent infusion of a different drug, or 96368 for a concurrent infusion when each code’s requirements are met. Report the drug supply separately when applicable. Under the CMS incident-to rule, the service is billed only when performed under physician supervision. Most Medicare services for this code are billed in offices.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 96365 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96365 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 96365 rate is calculated

Each of 96365’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 96365

The CMS indicators that decide how 96365 is paid alongside other services.

96365 compared with similar codes

How to choose

96374IV pushSingle or initial IV push

96374 covers an IV push, including drug administration lasting 15 minutes or less. Use 96365 for a qualifying nonchemotherapy drug infusion lasting more than 15 minutes.

96360Hydration infusionInitial service

96360 covers an initial IV infusion for hydration. Use 96365 for the initial infusion of a qualifying therapeutic, preventive, or diagnostic drug, following the administration hierarchy when both services occur.

96413Chemo IV infusionInitial drug, first hour

96413 applies to drugs classified for chemotherapy or complex biologic infusion administration. 96365 covers other qualifying drug infusions, such as IV antibiotics or iron.

96367Sequential IV infusionAdditional drug, up to one hour

96367 is an add-on for a different drug infused sequentially after the initial service. 96365 reports the initial qualifying therapeutic drug infusion.

Codes related to 96365

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates