Does 96372 require prior authorization?

No, 96372 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 96372?

Medicare facility rate: $15.36. Non-facility rate: $15.36. Work RVU: 0.17.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.17

Facility

$15.36

Non-Facility

$15.36

When Neulasta® or UDENYCA® is administered by prefilled syringe, report the drug HCPCS code (J2506 or Q5111) and the administration CPT code 96372 in the medical record/claim.
When Neulasta® or UDENYCA® is administered via an on-body injector (Neulasta® Onpro® or UDENYCA® ONBODY™), document and identify use of the on-body injector in the medical record and report CPT code 96377 (application of on-body injector).
Document that the provider filled the injector device and applied it to the patient (provider does not inject the drug manually) when billing for on-body injector use.
Medical records must document the indication(s) supporting use of IVIG for each claim.

Pegfilgrastim (Neulasta® or UDENYCA®) is covered to decrease the incidence of infection manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
IVIG is covered only for indications specified as covered in the related Local Coverage Determination (LCD) and when medical necessity criteria in that LCD are met.
Medicare may cover injectable testosterone pellets (Testopel) for males when used for an FDA‑approved indication and when the service meets Medicare coverage requirements in CMS Medicare Benefit Policy Manual, Chapter 15, §50.4.3.
Injectable testosterone pellet therapy may be used when alternative accepted routes (transdermal, oral, nasal, intramuscular) are clinically inappropriate or insufficient and medical necessity is documented.
Pegfilgrastim (J2506) is indicated to decrease the incidence of infection manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim may be administered via prefilled syringe or via an on-body injector (e.g., Neulasta Onpro or UDENYCA ONBODY) as approved delivery methods.

L34771 — Immune Globulins

J05

A57554 — Billing and Coding: Immune Globulins

J05

AETNA-CPB-0779 — Plerixafor

A54682 — Billing and Coding: Neulasta (pegfilgrastim) Onpro Kit / UDENYCA ONBODY (On-body Injector)

A57615 — Billing and Coding: Treatment of Males with Low Testosterone

Ask Verity about documentation requirements, denial risks, or coverage in your state.