Billing code 96522: Pump refillMedicare rate & RVUs in Utah
Reports refilling and maintaining an implanted pump or reservoir that delivers medication through a systemic route such as intravenous or intra-arterial access.
Medicare pays $118.06 for 96522 in the office in Utah (Utah). 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 96522 covers
This service covers accessing an implanted drug-delivery pump or reservoir, replenishing its medication supply, and performing the associated maintenance. It is used for implanted systems delivering medication through routes such as intravenous or intra-arterial access; an oncology example is a hepatic artery infusion pump. A physician or clinical staff member may perform the work in an office setting, with billing subject to the physician-supervision requirement described below.
Choose this code for an implanted system delivering medication systemically, rather than a portable pump or a pump delivering medication into the spinal or brain spaces. Document the implanted device and delivery route, the refill and maintenance performed, the medication and amount placed in the reservoir, and relevant pump checks. Under the CMS rule, this is an incident-to service and 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.
96522 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $118.06 | Unavailable |
How the 96522 rate is calculated
Each of 96522’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 · 96522
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.21Practice expense 3.47Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96522
The CMS indicators that decide how 96522 is paid alongside other services.
CMS payment indicators · 96522
Pump refill
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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. |
96522 compared with similar codes
Compare codes
96522 vs 96521 vs 96523 vs 62369 vs 62370: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96521Pump refill
- Choose 96522 for an implanted systemic-delivery pump or reservoir. Choose 96521 when the medication is delivered by a portable pump.
- 96523Irrig drug delivery device
- Code 96523 is for irrigation of an implanted venous access device. It does not describe replenishing an implanted medication pump reservoir.
- 62369Pump management
- Use 62369 for refill and maintenance of an implanted pump delivering medication into spinal or brain spaces when reprogramming is not performed; 96522 is for systemic delivery.
- 62370Pump refill
- Use 62370 for spinal or brain infusion-pump refill and maintenance when reprogramming is performed. Code 96522 describes an implanted pump for systemic drug delivery.
96522 billing questions
How does this differ from 96521?
Use 96522 for an implanted pump or reservoir delivering medication systemically. Code 96521 describes refill and maintenance of a portable pump.
Can 96522 be used for an intrathecal pump refill?
No. For an implanted pump delivering medication into spinal or brain spaces, use the applicable spinal or brain infusion-pump refill code, such as 62369 or 62370.
What documentation supports 96522?
Record the implanted pump type and delivery route, the refill and maintenance performed, the medication and amount placed, and relevant pump checks.
Who may perform the service for Medicare billing?
The CMS rule identifies this as an incident-to service: it may be billed only when performed under physician supervision.
Is flushing an implanted venous access device the same service?
No. Irrigation of an implanted venous access device is distinct from refilling and maintaining an implanted pump; 96523 describes the irrigation service.
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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