Billing code 96367: Sequential IV infusionMedicare rate & RVUs in Illinois
Report this add-on for a different therapeutic, prophylactic, or diagnostic drug infused through an IV after another drug during the same encounter.
Medicare pays $27.91–$30.65 for 96367 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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.
On this page 9 sections
What 96367 covers
This service covers a second or later IV infusion of a different drug or infusate mix, administered in sequence during the same encounter. A typical office or infusion-suite example is one IV antibiotic followed by a different IV medication through the same access. Nurses or other clinical staff usually administer and monitor the infusion under physician supervision. Administration lasting 15 minutes or less is classified as an IV push rather than an infusion.
Report 96367 with a qualifying primary administration code, such as 96365, 96374, 96409, or 96413; the initial code is selected under administration coding hierarchy, not simply by which drug ran first. CMS pays this add-on within the primary procedure’s global period. Each distinct sequential drug or infusate mix supports a unit; additional time on that infusion may support 96366 when it exceeds the first hour by more than 30 minutes. Document each drug, route, sequence, and start and stop times. In the office, this incident-to service requires physician supervision. A separately reportable drug may also have its own HCPCS code.
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 96367 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$27.91 to $30.65
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $30.32 | Unavailable |
| East St. Louis | $28.22 | Unavailable |
| Rest Of Illinois | $27.91 | Unavailable |
| Suburban Chicago | $30.65 | Unavailable |
How the 96367 rate is calculated
Each of 96367’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 · 96367
RVUs × geographic indexes × conversion factor
Work0.19
0.19 RVUs× 1.000 GPCI
Practice expense0.69
0.69 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.8900
Conversion factor
$33.4009
Medicare rate
$29.73
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96367
The CMS indicators that decide how 96367 is paid alongside other services.
CMS payment indicators · 96367
Sequential IV infusion
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| 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. |
96367 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96366IV infusion add-on hour
- Use 96366 for additional infusion time, including a sequential infusion that exceeds its first hour by more than 30 minutes. Use 96367 to identify the additional drug infused in sequence.
- 96368Concurrent infusion
- 96368 describes an additional drug infused concurrently with another infusion and is reported once per encounter. 96367 describes a different drug infused in sequence.
- 96375IV push add-on
- 96375 describes a new sequential drug given by IV push, including administration lasting 15 minutes or less. 96367 requires an infusion lasting longer than 15 minutes.
- 96361IV hydration
- 96361 captures additional hydration time after an initial hydration infusion. 96367 identifies a different therapeutic, prophylactic, or diagnostic drug infused in sequence.
96367 billing questions
Which primary codes can 96367 be reported with?
Qualifying initial administration codes include therapeutic infusion 96365, IV push 96374, chemotherapy push 96409, and chemotherapy infusion 96413. Select the initial code by administration coding hierarchy; 96367 cannot stand alone.
How is 96367 different from 96366?
96367 identifies an additional drug infused in sequence. 96366 captures additional infusion time, including time on a sequential infusion that exceeds its first hour by more than 30 minutes.
What if the second drug is administered over 15 minutes or less?
Administration lasting 15 minutes or less is classified as an IV push. For a new drug given in sequence, report 96375 rather than 96367.
Can 96367 be reported more than once per encounter?
Yes. Report a unit for each distinct drug or infusate mix infused in sequence; several drugs administered together as one mix constitute one infusion.
Is an E/M visit billable on the same day?
A significant, separately identifiable provider evaluation may be reported with modifier 25 on the E/M code. Routine staff assessment related to the infusion is part of administration.
Who can perform the service in the office?
Clinical staff such as infusion nurses usually administer and monitor the drug. For Medicare incident-to billing, the required physician supervision must be met.
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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