Does 96361 require prior authorization?

No, 96361 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 96361?

Medicare facility rate: $13.03. Non-facility rate: $13.03. Work RVU: 0.09.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.09

Facility

$13.03

Non-Facility

$13.03

Document a contemporaneous clinical assessment (typically same date) describing history, physical exam findings, and symptoms that support IV hydration, including inability to ingest fluids, contraindication to oral intake, abnormal fluid losses, or abnormal vital signs.
Include pertinent laboratory results in the record that support dehydration or volume loss (examples: elevated BUN, creatinine, glucose, or lactic acid) and note that nausea alone is insufficient to support IV hydration.
Record infusion start and stop times (administration 'starts dripping' to 'stops dripping') to calculate total infusion time and confirm the minimum 31-minute duration for reporting 96360.
Document that oral rehydration was inadequate or not feasible when that is the rationale for IV hydration, or document why IV hydration could not wait for an oral trial.

Use CPT 96360 (initial 31 minutes–1 hour) and 96361 (each additional hour) to report IV hydration consisting of pre-packaged fluids with or without electrolytes for patients presenting with dehydration or volume loss requiring clinically necessary intravenous fluid.
IV hydration is payable when medically necessary to correct dehydration or to prevent nephrotoxicity immediately before or after transfusion, chemotherapy, or administration of potentially nephrotoxic medications.
IV hydration is payable immediately before or after IV contrast administration for a diagnostic procedure in a patient with renal insufficiency.
In a physician office setting (Place of Service 11), the physician or clinical staff may report CPT 96360/96361 when they administer the fluids and medical necessity is documented.

A54635 — Billing and Coding: Hydration Services

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