$15.92
96369 reports the initial subcutaneous infusion service, up to one hour. 96370 is used for qualifying additional infusion time.
On this page
CMS RVU26D · Effective 2026-10-01
96369 Subcutaneous infusion Medicare reimbursement rates in Iowa
Reports the initial, up-to-one-hour service for a therapeutic or prophylactic medication delivered by subcutaneous infusion rather than a single injection. Compare 96369 office and facility rates across CMS payment localities in Iowa.
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 96369 in Iowa?
Iowa 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
$132.72
1 of 1 localities have a supported rate.
Payment area: Iowa
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.
Medication administration
About 96369: Initial subcutaneous therapeutic infusion
Reports the initial, up-to-one-hour service for a therapeutic or prophylactic medication delivered by subcutaneous infusion rather than a single injection.
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.
CMS billing rules for 96369
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.21 · 5%
- Practice expense (office) RVU4.10 · 94%
- Malpractice RVU0.03 · 1%
7.1K
Medicare services in 2024 · #1654 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.
96369 compared with similar codes
Office rates for Iowa, from the same CMS release.
$51.65
96369 reports the initial subcutaneous infusion service. 96371 is for an additional pump setup or establishment of another subcutaneous infusion site.
$14.37
96372 reports a single subcutaneous or intramuscular injection. 96369 is for medication delivered by subcutaneous infusion.
$61.33
Both codes describe an initial therapeutic, prophylactic, or diagnostic infusion, but 96365 is intravenous and 96369 is subcutaneous.
Compare 96369 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
Iowa →
Office / nonfacility
$132.72
Facility
Unavailable
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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 96369 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
12,783
- Code
- 96369
- Physician work
- 0.21
- Practice expense
- 4.10
- Malpractice
- 0.03
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.21 | × 1.000 | 0.2100 |
| Practice expense | 4.10 | × 0.915 | 3.7515 |
| Malpractice | 0.03 | × 0.397 | 0.0119 |
| Total RVUs | 3.9734 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$132.72
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.21 | 1 |
| Practice expense | 4.1 | 0.915 |
| Malpractice | 0.03 | 0.397 |
(0.21 × 1 + 4.1 × 0.915 + 0.03 × 0.397) × $33.4009 = $132.72
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.
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 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.
12,78096366,,Ther/proph/diag iv inf addon,A,,0.18,0.45,,0.45,NA,0.01,0.64,0.64,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78196367,,Tx/proph/dg addl seq iv inf,A,,0.19,0.69,,0.69,NA,0.01,0.89,0.89,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78296368,,Ther/diag concurrent inf,A,,0.17,0.44,,0.44,NA,0.01,0.62,0.62,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78396369,,Sc ther infusion up to 1 hr,A,,0.21,4.10,,4.10,NA,0.03,4.34,4.34,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78496370,,Sc ther infusion addl hr,A,,0.18,0.32,,0.32,NA,0.01,0.51,0.51,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78596371,,Sc ther infusion reset pump,A,,0.00,1.69,,1.69,NA,0.00,1.69,1.69,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78696372,,Ther/proph/diag inj sc/im,A,,0.17,0.28,,0.28,NA,0.01,0.46,0.46,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136