CPT 96367
Global ZZZ ActiveTx/proph/dg addl seq iv inf
CPT 96367 Billing & Documentation Guide
CPT code 96367 (Tx/proph/dg addl seq iv inf) is classified under Infusion/Chemotherapy with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.19, a non-facility practice expense RVU of 0.69, and a malpractice RVU of 0.01, a total non-facility RVU of 0.89 and facility RVU of 0.89. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $30.81, though rates vary from $26.32 to $40.46 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96367, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96367 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 4 units of 96367 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 96367
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.19 | 0.19 |
| Practice Expense RVU | 0.69 | 0.69 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.89 | 0.89 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96367
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $34.02 | $34.02 | $31.89 - $40.46 | 29 |
| Florida | $30.12 | $30.12 | $28.88 - $31.18 | 3 |
| Georgia | $28.74 | $28.74 | $27.3 - $30.18 | 2 |
| Illinois | $29.28 | $29.28 | $27.91 - $30.65 | 4 |
| Michigan | $28.46 | $28.46 | $27.76 - $29.15 | 2 |
| North Carolina | $28.06 | $28.06 | $28.06 - $28.06 | 1 |
| New York | $32.81 | $32.81 | $28.48 - $34.78 | 5 |
| Ohio | $27.72 | $27.72 | $27.72 - $27.72 | 1 |
| Pennsylvania | $29.34 | $29.34 | $27.82 - $30.85 | 2 |
| Texas | $29.38 | $29.38 | $27.63 - $31.04 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96367
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96367 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0543T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0572T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0573T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0574T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 96367
What does CPT code 96367 mean? +
CPT code 96367 represents: Tx/proph/dg addl seq iv inf. It's in the Infusion/Chemotherapy category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 96367? +
The 2026 Medicare national average non-facility payment for CPT 96367 is $30.81. Rates range from $26.32 to $40.46 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96367? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96367? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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