CPT 96522
Global XXX ActiveRefill/maint pump/resvr syst
CPT 96522 Billing & Documentation Guide
CPT code 96522 (Refill/maint pump/resvr syst) 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 3.47, and a malpractice RVU of 0.07, a total non-facility RVU of 3.75 and facility RVU of 3.75. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $130.12, though rates vary from $107.78 to $176.17 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96522, 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 96522 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 96522 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 96522
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.21 | 0.21 |
| Practice Expense RVU | 3.47 | 3.47 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 3.75 | 3.75 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96522
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 | $145.67 | $145.67 | $135.41 - $176.17 | 29 |
| Florida | $127.85 | $127.85 | $121.33 - $133.58 | 3 |
| Georgia | $120.39 | $120.39 | $113.18 - $127.6 | 2 |
| Illinois | $123.5 | $123.5 | $116.49 - $130.24 | 4 |
| Michigan | $119.13 | $119.13 | $115.47 - $122.8 | 2 |
| North Carolina | $116.64 | $116.64 | $116.64 - $116.64 | 1 |
| New York | $139.82 | $139.82 | $118.76 - $149.61 | 5 |
| Ohio | $115.19 | $115.19 | $115.19 - $115.19 | 1 |
| Pennsylvania | $123.1 | $123.1 | $115.62 - $130.58 | 2 |
| Texas | $123.33 | $123.33 | $114.66 - $131.72 | 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 96522
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96522 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 |
| 49010 | Column 1 (primary), can be billed with modifier | No | CPT Separate procedure definition |
| 77401 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77402 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77403 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77404 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77406 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77407 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 77408 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 96522
What does CPT code 96522 mean? +
CPT code 96522 represents: Refill/maint pump/resvr syst. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96522? +
The 2026 Medicare national average non-facility payment for CPT 96522 is $130.12. Rates range from $107.78 to $176.17 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96522? +
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 96522? +
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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