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Injectable Drugs

The applicable Healthcare Common Procedure Coding Systems (HCPCS)/ Current Procedural Terminology (CPT) injectable drug administration code (96372) can be billed for administration of each separate injection. The HCPCS/CPT drug code can also be billed in addition to the administration code. Preferred Medical Doctors (PMDs) are reimbursed one administrative allowance for each separate injection. If multiple drugs are administered through the same syringe, only one administration code should be billed.

Do not report 96372 for injections given without direct physician or other qualified healthcare professional supervision. To report, use 99211.

Professional claims processed on or after June 27, 2011, for physician administered/distributed drugs will require the National Drug Code (NDC) to be included on the claim. The NDC will be required for all drugs including, but not limited to: injectable vaccines, oncology drugs, intranasal vaccines, topical therapies, inhalation drugs, and radiopharmaceuticals and contrast agents where the NDC is available. The NDC will be required on all claims for professional providers, including non-participating providers, Blue Advantage® claims and on member-filed claims.

Some drugs have several codes assigned to indicate different strengths. If a code exists for the administered strength of the drug, use that code instead of multiple numbers of services on the code representing the lesser strength. Multiple numbers of services for a drug should only be billed when the dosage administered is greater than the specific code.

Blue Cross and Blue Shield of Alabama updates the injectable drug fee schedule as needed, based on the average wholesale price (AWP) from public sources. Medi-Span and Redbook are the most common source used for AWP.

Last Updated June 2015