$143.10
96369 represents the initial subcutaneous infusion service, while 96370 represents qualifying additional infusion time beyond that initial service.
On this page
CMS RVU26D · Effective 2026-10-01
96370 Subcutaneous infusion Medicare reimbursement rates in Vermont
Report an additional hour when a therapeutic, prophylactic, or diagnostic medication continues by subcutaneous infusion beyond the initial service. Compare 96370 office and facility rates across CMS payment localities in Vermont.
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 96370 in Vermont?
Vermont 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
$16.76
1 of 1 localities have a supported rate.
Payment area: Vermont
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.
Therapeutic infusion
About 96370: Additional hour of subcutaneous infusion
Report an additional hour when a therapeutic, prophylactic, or diagnostic medication continues by subcutaneous infusion beyond the initial service.
This add-on represents additional time for a medication delivered by continuous subcutaneous infusion, typically through an infusion pump and subcutaneous site. It is used in office or outpatient care when the infusion continues beyond the initial hour represented by 96369. Clinical staff commonly perform the infusion under physician supervision as an incident-to service.
Report it with 96369, the primary subcutaneous infusion service, only when documented infusion time extends more than 30 minutes beyond the initial hour. Record the medication, subcutaneous route, start and stop times, total infusion duration, and relevant pump or site details. CMS treats 96370 as an add-on paid within the primary procedure's global period. It is billed only when performed under physician supervision; it is not a separate professional or technical component.
CMS billing rules for 96370
- 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 · 35%
- Practice expense (office) RVU0.32 · 63%
- Malpractice RVU0.01 · 2%
4.8K
Medicare services in 2024 · #1901 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.
96370 compared with similar codes
Office rates for Vermont, from the same CMS release.
$55.88
96371 addresses additional pump setup or infusion sites; 96370 addresses additional infusion duration.
$15.11
96372 is for a subcutaneous or intramuscular injection. Use 96370 only when medication is delivered by subcutaneous infusion for additional time.
$21.06
96366 represents additional time for an intravenous infusion. 96370 is for additional time with a subcutaneous infusion.
Compare 96370 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
Vermont →
Office / nonfacility
$16.76
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 96370 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
12,784
- Code
- 96370
- Physician work
- 0.18
- Practice expense
- 0.32
- Malpractice
- 0.01
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.18 | × 1.000 | 0.1800 |
| Practice expense | 0.32 | × 0.990 | 0.3168 |
| Malpractice | 0.01 | × 0.506 | 0.0051 |
| Total RVUs | 0.5019 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$16.76
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.18 | 1 |
| Practice expense | 0.32 | 0.99 |
| Malpractice | 0.01 | 0.506 |
(0.18 × 1 + 0.32 × 0.99 + 0.01 × 0.506) × $33.4009 = $16.76
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.
96370 billing questions
Can 96370 be billed without 96369?
No. It is an add-on for additional subcutaneous infusion time and must be reported with the primary infusion service, 96369.
When does the additional hour qualify?
The documented infusion must extend more than 30 minutes beyond the initial hour. Record actual start and stop times to support the additional time.
How is 96370 different from 96371?
96370 represents additional infusion time. 96371 is for additional pump setup or subcutaneous infusion site work, rather than another hour of infusion.
Is 96370 appropriate for a subcutaneous injection?
No. It represents continuing subcutaneous infusion time. A therapeutic, prophylactic, or diagnostic subcutaneous injection is represented by 96372 when that service is performed.
What supervision is required?
CMS identifies this as an incident-to service, so it is billed only when performed under physician supervision.
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.
12,78196367,,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
12,78796373,,Ther/proph/diag inj ia,A,,0.17,0.41,,0.41,NA,0.01,0.59,0.59,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817