$67.76
96365 reports the initial therapeutic, prophylactic, or diagnostic IV infusion. For a single-drug infusion, add 96366 when administration reaches 91 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
96366 IV infusion add-on hour Medicare reimbursement rates in Puerto Rico
Report each qualifying additional hour of a therapeutic, prophylactic, or diagnostic IV drug infusion after an initial or sequential infusion's first hour. Compare 96366 office and facility rates across CMS payment localities in Puerto Rico.
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 96366 in Puerto Rico?
Puerto Rico 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
$21.54
1 of 1 localities have a supported rate.
Payment area: Puerto Rico
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.
Drug administration
About 96366: Therapeutic IV infusion, each additional hour
Report each qualifying additional hour of a therapeutic, prophylactic, or diagnostic IV drug infusion after an initial or sequential infusion's first hour.
This code captures continued IV administration of a therapeutic, prophylactic, or diagnostic drug after the infusion's first hour. Examples include standard infusions of IV antibiotics, iron, and immune globulin. In a physician office or infusion suite, an infusion nurse or other clinical staff typically starts, monitors, and stops the infusion under physician supervision. The substance administered and the service's complexity determine whether this infusion family is appropriate.
Report 96366 with 96365 when an initial drug infusion lasts at least 91 minutes. It can also extend a qualifying sequential infusion reported with 96367 and its required primary administration code. Report one unit for each additional hour that meets the time threshold; a final increment must exceed 30 minutes. Record the start and stop times for each drug, along with its identity, dose, and route. CMS treats 96366 as an add-on paid within the primary procedure's global period, so it cannot be billed alone. As an incident-to service, it is billed only when performed under physician supervision. Report a separately billable drug supply with its appropriate HCPCS code and units.
CMS billing rules for 96366
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.18 · 28%
- Practice expense (office) RVU0.45 · 70%
- Malpractice RVU0.01 · 2%
635.7K
Medicare services in 2024 · #198 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.
96366 compared with similar codes
Office rates for Puerto Rico, from the same CMS release.
$13.13
96361 reports an additional hour of IV hydration. Use 96366 for qualifying additional time administering a therapeutic, prophylactic, or diagnostic drug.
$28.62
96415 extends chemotherapy or other highly complex infusion administration. Use 96366 when the drug and administration qualify for the standard therapeutic infusion family.
$29.98
96367 reports a sequential infusion of a new drug after another administration service. Add 96366 when that sequential infusion has qualifying time beyond its first hour.
Compare 96366 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
Puerto Rico →
Office / nonfacility
$21.54
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 96366 in Puerto Rico.
PPRRVU2026_Oct_nonQPP.csv
12,780
- Code
- 96366
- Physician work
- 0.18
- Practice expense
- 0.45
- Malpractice
- 0.01
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.000 | 0.1800 |
| Practice expense | 0.45 | × 1.011 | 0.4549 |
| Malpractice | 0.01 | × 0.985 | 0.0098 |
| Total RVUs | 0.6448 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Puerto Rico$21.54
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.45 | 1.011 |
| Malpractice | 0.01 | 0.985 |
(0.18 × 1 + 0.45 × 1.011 + 0.01 × 0.985) × $33.4009 = $21.54
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.
96366 billing questions
How many minutes past the first hour are needed to bill this code?
The additional time must exceed 30 minutes beyond the first hour. A single-drug infusion lasting 61 to 90 minutes supports 96365 alone; at 91 minutes, it supports one unit of 96366.
Can this code be reported with a sequential infusion code?
Yes. If a sequential infusion of a different drug reported with 96367 runs long enough, 96366 captures its qualifying additional time. The encounter must also include the required primary administration code.
Should this code be used for extra hours of hydration or chemotherapy?
No. Additional hydration hours are reported with 96361. Additional hours of chemotherapy or other highly complex infusion administration are reported with 96415.
How are units counted for a long infusion?
Report one unit for each qualifying additional hour. A four-hour infusion of a drug appropriately reported under 96365 supports 96365 plus three units of 96366.
Who can perform the service and how is it billed?
Clinical staff such as an infusion nurse typically perform it. CMS identifies it as an incident-to service billed only when performed under physician supervision; documented start and stop times support the units.
Is the drug included in this code?
No. 96366 reports additional administration time; report a separately billable infused drug with its appropriate HCPCS drug code and units.
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.
12,77796360,,Hydration iv infusion init,A,,0.17,0.82,,0.82,NA,0.01,1.00,1.00,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77896361,,Hydrate iv infusion add-on,A,,0.09,0.29,,0.29,NA,0.01,0.39,0.39,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,77996365,,Ther/proph/diag iv inf init,A,,0.21,1.76,,1.76,NA,0.04,2.01,2.01,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,78096366,,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
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703
8912502,PA,01,METROPOLITAN PHILADELPHIA,1.018,1.041,1.193
9012502,PA,99,REST OF PENNSYLVANIA,1.000,0.918,0.945
9109202,PR,20,PUERTO RICO,1.000,1.011,0.985
9214412,RI,01,RHODE ISLAND,1.019,1.033,0.892
9311202,SC,01,SOUTH CAROLINA,1.000,0.924,0.850
9403402,SD,02,SOUTH DAKOTA**,1.000,1.000,0.336