CPT 96368
Global ZZZ ActiveTher/diag concurrent inf
CPT 96368 Billing & Documentation Guide
CPT code 96368 (Ther/diag concurrent inf) is classified under Infusion/Chemotherapy with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.17, a non-facility practice expense RVU of 0.44, and a malpractice RVU of 0.01, a total non-facility RVU of 0.62 and facility RVU of 0.62. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $21.42, though rates vary from $18.47 to $27.67 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96368, 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 96368 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 1 units of 96368 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 96368
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.17 | 0.17 |
| Practice Expense RVU | 0.44 | 0.44 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.62 | 0.62 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96368
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 | $23.45 | $23.45 | $22.06 - $27.67 | 29 |
| Florida | $21.07 | $21.07 | $20.23 - $21.82 | 3 |
| Georgia | $20.11 | $20.11 | $19.19 - $21.03 | 2 |
| Illinois | $20.54 | $20.54 | $19.62 - $21.4 | 4 |
| Michigan | $19.95 | $19.95 | $19.47 - $20.42 | 2 |
| North Carolina | $19.6 | $19.6 | $19.6 - $19.6 | 1 |
| New York | $22.8 | $22.8 | $19.87 - $24.14 | 5 |
| Ohio | $19.43 | $19.43 | $19.43 - $19.43 | 1 |
| Pennsylvania | $20.49 | $20.49 | $19.49 - $21.48 | 2 |
| Texas | $20.49 | $20.49 | $19.36 - $21.53 | 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 96368
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96368 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 96368
What does CPT code 96368 mean? +
CPT code 96368 represents: Ther/diag concurrent inf. It's in the Infusion/Chemotherapy category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 96368? +
The 2026 Medicare national average non-facility payment for CPT 96368 is $21.42. Rates range from $18.47 to $27.67 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96368? +
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 96368? +
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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