Billing code 96371: Infusion setupMedicare rate & RVUs in Illinois
Reports an additional pump setup or newly established subcutaneous infusion site during a therapeutic, prophylactic, or diagnostic subcutaneous infusion.
Medicare pays $51.54–$57.97 for 96371 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 96371 covers
This add-on captures an additional pump setup or establishment of a new subcutaneous infusion site during a therapeutic, prophylactic, or diagnostic infusion. It represents setup or site work, not additional infusion time. Clinical staff commonly perform the hands-on work in an office or infusion setting.
Report 96371 only with a primary subcutaneous infusion service, such as 96369 or 96370, when the additional setup or site is performed. Document the infusion and the additional pump setup or site established. CMS classifies 96371 as an add-on, billed only with a primary procedure and paid within that procedure’s global period. As an incident-to service, it may be billed only when performed under physician supervision.
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 96371 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
$51.54 to $57.97
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $56.73 | Unavailable |
| East St. Louis | $51.93 | Unavailable |
| Rest Of Illinois | $51.54 | Unavailable |
| Suburban Chicago | $57.97 | Unavailable |
How the 96371 rate is calculated
Each of 96371’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 · 96371
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense1.69
1.69 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
1.6900
Conversion factor
$33.4009
Medicare rate
$56.45
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96371
The CMS indicators that decide how 96371 is paid alongside other services.
CMS payment indicators · 96371
Infusion setup
| 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. |
96371 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96369Subcutaneous infusion
- 96369 reports the primary subcutaneous infusion service for up to one hour. Use 96371 for additional pump setup or establishment of a new site during that infusion.
- 96370Subcutaneous infusion
- 96370 reports qualifying additional infusion time. 96371 reports additional pump setup or a new site, rather than another hour.
- 96372SC/IM injection
- 96372 is for a therapeutic, prophylactic, or diagnostic subcutaneous or intramuscular injection. 96371 is an add-on for additional setup or a new site during subcutaneous infusion.
96371 billing questions
When is 96371 reported with 96369 or 96370?
Report 96371 with a primary subcutaneous infusion service when an additional pump setup or new infusion site is established. The primary infusion code represents the infusion service; 96371 represents the additional setup or site work.
Is 96371 an additional-hour code?
No. It reports additional pump setup or establishment of a new subcutaneous infusion site, not another hour of infusion time. Use 96370 for qualifying additional infusion time.
What documentation supports 96371?
Document the subcutaneous infusion and the additional pump setup or newly established site. The record should make clear what additional setup or site work was performed.
Can 96371 be billed by itself?
No. CMS identifies 96371 as an add-on code that must be billed with a primary procedure, such as 96369 or 96370.
Who may perform the service for billing?
CMS identifies 96371 as an incident-to service. It may be billed only when performed under physician supervision.
How does 96371 differ from 96372?
96371 describes additional setup or a new site during a subcutaneous infusion. 96372 describes a therapeutic, prophylactic, or diagnostic subcutaneous or intramuscular injection.
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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