A single infusion visit can involve four or five CPT codes, and getting the chemo-drug-hydration hierarchy wrong is the single biggest source of infusion denials — with unbilled drug wastage worth hundreds to thousands of dollars per encounter on biologics like rituximab and infliximab.
Common Billing Challenges
These are the six billing failure points we see most often in infusion practices — and the ones our team resolves systematically from day one.
Chemo infusion outranks therapeutic drug infusion, which outranks hydration. Bill hydration as primary when a drug infusion happened the same day and it's an automatic bundling denial.
The clock starts at infusion begin, not when the bag goes up. A 70-minute infusion only supports 96365 alone — you need a full 30 additional minutes documented to add 96366.
On expensive biologics like rituximab, infliximab, and trastuzumab, an unbilled partial-vial discard can represent hundreds to thousands of dollars per encounter.
Billing 96360 alongside a same-day drug infusion is an automatic bundling edit for most payers unless there's a separately documented clinical reason.
Place of service changes the reimbursement rate and whether J-codes are separately payable — POS 11 (office) and POS 22 (hospital outpatient) aren't interchangeable.
An authorization for rituximab doesn't cover infliximab. A physician switching biologics mid-cycle without a new auth is one of the most common causes of infusion denials.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in infusion therapy.
| CPT Code | Description | Common Issue |
|---|---|---|
| 96365 | IV infusion, initial up to 1 hour | Primary code for therapeutic drug infusion |
| 96366 | IV infusion, each additional hour | Add-on; requires 30+ additional minutes documented |
| 96367 | Additional sequential infusion, each drug | Different drug after primary infusion ends |
| 96368 | Concurrent infusion | Different drug running simultaneously — once per day max |
| 96360/96361 | Hydration, initial / additional hour | Not billable if a drug infusion occurred the same day |
| 96413 | Chemo infusion, initial up to 1 hour | Always primary when billed with other same-day infusions |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to infusion therapy — not a generic CPC only.
Significantly above the denial rate practices see from infusion hierarchy and J-code sequencing errors — the single biggest driver of infusion claim denials.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your surgical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.