CPT code 96369: Subcutaneous infusion, initial, up to one hour2026 Medicare rate & RVUs in Florida
Reports the initial, up-to-one-hour service for a therapeutic or prophylactic medication delivered by subcutaneous infusion rather than a single injection.
Medicare pays $139.44–$152.11 for 96369 in the office in Florida, from Rest of Florida to Miami, FL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 96369 covers
This service covers starting a therapeutic or prophylactic medication infusion through a subcutaneous site, including setting up the infusion and establishing the site or sites. It is distinct from a one-time subcutaneous injection: the medication is delivered by infusion, commonly using an infusion pump. In an office setting, clinical staff may perform the administration as part of the physician-supervised service.
Report 96369 for the initial infusion service, up to one hour; documentation should support the medication, subcutaneous route, infusion start and stop times, and work performed to establish the infusion. For Medicare, this is an incident-to service and may be billed only when performed under physician supervision. The drug itself is not the administration service represented by this code; report it separately when appropriate under the applicable drug billing rules.
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 96369 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$139.44 to $152.11
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | $147.55 | Unavailable |
| Miami, FL | $152.11 | Unavailable |
| Rest of Florida | $139.44 | Unavailable |
How the 96369 rate is calculated
Each of 96369’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.
How the rate is built · 96369
RVUs × geographic indexes × conversion factor
Work0.21
0.21 RVUs× 1.000 GPCI
Practice expense4.10
4.10 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
4.3400
Conversion factor
$33.4009
Medicare rate
$144.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96369
The CMS indicators that decide how 96369 is paid alongside other services.
CMS payment indicators · 96369
Subcutaneous infusion, initial, up to one hour
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
96369 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96370Subcutaneous infusionEach additional hour
- 96369 reports the initial subcutaneous infusion service, up to one hour. 96370 is used for qualifying additional infusion time.
- 96371Infusion setupAdditional pump setup or site
- 96369 reports the initial subcutaneous infusion service. 96371 is for an additional pump setup or establishment of another subcutaneous infusion site.
- 96372SC/IM injectionTherapeutic, prophylactic, or diagnostic
- 96372 reports a single subcutaneous or intramuscular injection. 96369 is for medication delivered by subcutaneous infusion.
- 96365IV drug infusionInitial, first hour
- Both codes describe an initial therapeutic, prophylactic, or diagnostic infusion, but 96365 is intravenous and 96369 is subcutaneous.
96369 billing questions
When should 96369 be used instead of 96372?
Use 96369 for a medication delivered through a subcutaneous infusion. Use 96372 for a therapeutic, prophylactic, or diagnostic subcutaneous or intramuscular injection, not an infusion.
What documentation supports 96369?
Document the drug, subcutaneous route, infusion start and stop times, and establishment of the infusion site. The record should distinguish the infusion from a single injection.
Can 96369 be reported for additional infusion time?
96369 represents the initial service up to one hour. Report 96370 for qualifying additional infusion time, following the applicable CPT timing instructions.
Can 96369 be billed when staff perform the infusion?
For Medicare, the service is incident-to and may be billed only when performed under physician supervision.
Is the medication included in 96369?
96369 represents the administration service, not the medication itself. Report the drug separately when appropriate under the applicable drug billing rules.
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
Show the CMS file lines behind this rate
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