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CMS RVU26D · Effective 2026-10-01

96365 IV drug infusion Medicare reimbursement rates in Guam

Report the initial hour of a nonchemotherapy IV drug infusion lasting more than 15 minutes for treatment, prevention, or diagnosis. Compare 96365 office and facility rates across CMS payment localities in Guam.

Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.

What does Medicare pay for 96365 in Guam?

Guam has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.

Office / nonfacility

$74.63

1 of 1 localities have a supported rate.

Payment area: Hawaii, Guam

One mapped payment locality.

Facility setting

No supported rate

These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.

Find 96365 in your payment locality →

Drug administration

About 96365: Initial nonchemotherapy IV drug infusion, first hour

Report the initial hour of a nonchemotherapy IV drug infusion lasting more than 15 minutes for treatment, prevention, or diagnosis.

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.

CMS billing rules for 96365

Professional and technical components
Incident-to service: billed only when performed under physician supervision.

Where the value comes from

  • Work RVU0.21 · 10%
  • Practice expense (office) RVU1.76 · 88%
  • Malpractice RVU0.04 · 2%

1.4M

Medicare services in 2024 · #114 by national volume

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.

96365 compared with similar codes

Office rates for Guam, from the same CMS release.

96374

IV push

Single or initial IV push

$41.72

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.

96360

Hydration infusion

Initial service

$37.01

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.

96413

Chemo IV infusion

Initial drug, first hour

$148.94

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

96367

Sequential IV infusion

Additional drug, up to one hour

$32.74

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

Compare 96365 by payment locality

Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.

1 of 1 payment localities

Office and facility base rates · shared scale starting at $0

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How this local rate is calculated

Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96365 in Hawaii, Guam.

PPRRVU2026_Oct_nonQPP.csv

12,779

Code
96365
Physician work
0.21
Practice expense
1.76
Malpractice
0.04

GPCI2026.csv

46

Locality
Hawaii, Guam
Physician work
1.000
Practice expense
1.137
Malpractice
0.579
Office / nonfacility calculation for 96365 in Hawaii, Guam
ComponentRVULocality factorAdjusted
Physician work0.21× 1.0000.2100
Practice expense1.76× 1.1372.0011
Malpractice0.04× 0.5790.0232
Total RVUs2.2343
Conversion factor× 33.4009

Office / nonfacility rate, Hawaii, Guam$74.63

Explore RVUs, geographic factors and the full formula

Office / nonfacility

Office / nonfacility calculation inputs
ComponentRVULocal GPCI
Work0.211
Practice expense1.761.137
Malpractice0.040.579

(0.21 × 1 + 1.76 × 1.137 + 0.04 × 0.579) × $33.4009 = $74.63

The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.

96365 billing questions

What is the minimum infusion time for this code?

The infusion must last more than 15 minutes. If administration takes 15 minutes or less, report the appropriate IV push code instead; documented start and stop times support the choice.

When do I add 96366?

Add 96366 when the same infusion continues beyond the first hour by more than 30 minutes. The first add-on unit requires at least 91 minutes of total infusion time.

Can I bill 96365 twice on the same day?

Usually only one initial administration service is reported per encounter. Another may be supported by a separate encounter or a protocol requiring distinct IV sites; document the circumstances and use an appropriate distinct-service modifier when required.

Is an office E/M visit separately billable with 96365?

Yes, when a significant, separately identifiable E/M service is documented; append modifier 25 to the E/M code. Routine infusion assessment and monitoring are included in 96365.

How is a second drug given after the first infusion reported?

Report 96367 for a sequential infusion of a different drug lasting more than 15 minutes, or 96375 if the new drug is given by IV push. Use 96368 for a qualifying concurrent infusion.

Should a monoclonal antibody or biologic be billed with 96365?

The administration code depends on the drug’s classification. Infusions classified for chemotherapy or complex biologic administration use codes such as 96413 rather than 96365.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.

Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.

RVUs for 96365PPRRVU2026_Oct_nonQPP.csv, line 12,779 (RVU26D)
Geographic factors for Hawaii, GuamGPCI2026.csv, line 46 (RVU26D)
Open CMS sourceHow this rate is calculatedBuild a fee sheet