Infusion CPT Codes for 2026 + Modifiers

Check out the latest CPT codes and modifiers for infusion

Read Time: 2 minutes
Jan 4, 2026

Infusion centers administer a broad range of therapies—from hydration and antibiotics to chemotherapy and complex biologics. Accurate use of infusion CPT codes and modifiers for 2026 is essential to support reimbursement, document medical necessity, and stay compliant with payer billing rules.

Initial Infusion Services

Infusion coding starts with choosing the correct initial service based on the primary substance and method of administration. Payers apply hierarchy rules and sequencing guidelines, so selecting the right “initial” code is critical.

CPT Code	Description
96365	IV infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hour
96360	IV hydration infusion, initial, up to 1 hour
96413	Chemotherapy/complex drug infusion, initial, up to 1 hour
96401	Chemotherapy administration, subcutaneous or intramuscular

Initial Code and Hierarchy Reminders

Tip: When multiple drug administration services occur in the same encounter, follow hierarchy rules (chemotherapy/complex > therapeutic > hydration). In addition, only one “initial” drug administration service is typically reported per vascular access site per encounter; separate IV access sites must be clearly documented when applicable.

Additional Hours and Concurrent Infusions

Time-based services require clear infusion start/stop times. Additional-hour and concurrent codes are payable only when documentation supports the duration, sequencing, and distinct substances administered.

CPT Code	Description
96366	Each additional hour of therapeutic infusion
96361	Each additional hour of hydration infusion
96415	Each additional hour of chemotherapy/complex drug infusion
96368	Concurrent infusion during a primary service

IV Push and Injection Services

IV push services are billed differently than infusions and are frequently reviewed by payers. Document administration method and sequencing (initial vs. additional sequential substances) to support correct reporting.

CPT Code	Description
96374	Therapeutic or diagnostic IV push, single or initial substance
96375	Each additional sequential IV push of a different substance
96372	Therapeutic injection, intramuscular or subcutaneous

Common Drug Administration Scenarios

These examples illustrate how infusion services are commonly reported. Always confirm payer policy when classifying complex biologics and monoclonal antibody therapies.

Scenario	Example	Coding Approach
Antibiotic infusion	IV ceftriaxone	96365 (+96366 if over 1 hour)
Hydration therapy	IV normal saline	96360 (+96361 if over 1 hour)
Chemotherapy/monoclonal antibody infusion	IV rituximab	96413 (+96415 if over 1 hour) (verify payer classification)
IV push steroid	IV methylprednisolone	96374

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Infusion Billing Modifiers

Modifier accuracy matters in infusion billing, especially for single-dose drugs and multi-service visits. Many payers have specific requirements for drug wastage reporting and distinct services.

Modifier	Description
-59	Distinct procedural service (use when supported by documentation and payer rules)
-25	Significant, separately identifiable E/M service
-91	Repeat laboratory or diagnostic test
-JW	Drug amount discarded and not administered to any patient (single-dose/single-use)
-JZ	No drug discarded (single-dose/single-use; required by Medicare for applicable Part B drugs)
-JG	Drug acquired at a 340B discounted price (as applicable)

JW vs. JZ in 2026

Tip: For Medicare Part B separately payable drugs from single-dose containers, report JW when there is discarded drug and JZ when there is no discarded amount. Claims may be rejected or returned if the appropriate modifier is missing.

Common ICD-10-CM Codes for Infusion Centers

Diagnosis coding should support the medical necessity of infused drugs and related services. The following ICD-10-CM codes are commonly used in infusion settings.

ICD-10 Code	Description
Z51.11	Encounter for antineoplastic chemotherapy
Z51.12	Encounter for antineoplastic immunotherapy
Z51.81	Encounter for therapeutic drug monitoring (as applicable)
E86.0	Dehydration
J44.1	Chronic obstructive pulmonary disease with acute exacerbation
M05.79	Rheumatoid arthritis with organ involvement
R50.9	Fever, unspecified

Infusion Billing Tips for 2026

Apply hierarchy rules consistently. Chemotherapy/complex drug administration generally takes priority over therapeutic infusions, which take priority over hydration.
Remember the “initial” rule. Only one initial administration code is typically reported per vascular access site per encounter; document distinct access sites when applicable.
Document infusion times. Start/stop times should support all time-based infusion reporting.
Use JW and JZ correctly. For applicable single-dose drugs, report JW when there is discarded drug and JZ when there is no discarded amount.
Ensure hydration is medically necessary. Routine hydration without clinical support is frequently denied.

Final Thoughts

Infusion billing is one of the most detail-driven areas of medical coding. Accurate use of infusion CPT codes and modifiers for 2026 helps capture billable time, support drug wastage reporting, reduce denials, and maintain compliance with evolving payer expectations.

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For informational purposes only.