CPT 96369
Global XXX ActiveSc ther infusion up to 1 hr
CPT 96369 Billing & Documentation Guide
CPT code 96369 (Sc ther infusion up to 1 hr) is classified under Infusion/Chemotherapy with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.21, a non-facility practice expense RVU of 4.1, and a malpractice RVU of 0.03, a total non-facility RVU of 4.34 and facility RVU of 4.34. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $150.93, though rates vary from $125.16 to $205.8 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96369, 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 96369 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 96369 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 96369
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.21 | 0.21 |
| Practice Expense RVU | 4.1 | 4.1 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 4.34 | 4.34 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96369
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 | $169.85 | $169.85 | $157.76 - $205.8 | 29 |
| Florida | $146.37 | $146.37 | $139.44 - $152.11 | 3 |
| Georgia | $138.87 | $138.87 | $130.36 - $147.37 | 2 |
| Illinois | $141.28 | $141.28 | $133.61 - $149.48 | 4 |
| Michigan | $137.02 | $137.02 | $133.18 - $140.85 | 2 |
| North Carolina | $135.42 | $135.42 | $135.42 - $135.42 | 1 |
| New York | $161.49 | $161.49 | $137.82 - $172.15 | 5 |
| Ohio | $133.05 | $133.05 | $133.05 - $133.05 | 1 |
| Pennsylvania | $142.29 | $142.29 | $133.68 - $150.89 | 2 |
| Texas | $142.8 | $142.8 | $132.56 - $152.8 | 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 96369
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96369 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 64450 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64454 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64473 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64474 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64486 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64487 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64488 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64489 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96369
What does CPT code 96369 mean? +
CPT code 96369 represents: Sc ther infusion up to 1 hr. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96369? +
The 2026 Medicare national average non-facility payment for CPT 96369 is $150.93. Rates range from $125.16 to $205.8 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96369? +
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 96369? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team