Codes for Drug Administration
Drug administration services are reported on claim forms in both the physician office (CMS-
1500) and hospital outpatient (CMS-1450) sites of care using the CPT® coding system. The
CPT® codes most commonly associated with the administration of REMICADE® are:
• 96413 - Chemotherapy administration, intravenous infusion technique; up to 1 hour,
single or initial substance/drug, and
• 96415 - Each additional hour (Use 96415 in conjunction with 96413; report 96415
for infusion intervals of greater than 30 minutes beyond 1 hour increments.)
Alternatively, some payers may require the use of CPT® codes:
• 96365 - Intravenous infusion for therapy, prophylaxis, or diagnosis (specify
substance or drug); initial, up to 1 hour, and
• 96366 - Each additional hour (List separately in addition to code for primary
procedure; report 9636
Payer policies for codes used to describe infusion services may vary. Consult your payers
for policies regarding use of 96413 and 96415 or 96365 and 96366. For additional
assistance, contact Janssen CarePath at https://www.JansenCarePath.com/hcp/remicade
or 877-CarePath (877-227-3728).
SAMPLE CLAIM FORMS
The Form CMS-1500 is the basic form prescribed by CMS for the Medicare and Medicaid
programs for claims from suppliers and non-institutional providers that qualify for a waiver
from the Administrative Simplification Compliance Act (ASCA) requirement for electronic
submission of claims. It has also been adopted by the TRICARE Program. For detailed
guidance on completing the CMS-1500 items, please see the Medicare Claims Processing
Manual, Pub. 100-04, Chapter 26, available at:
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26.pdf
The 837P (Professional) is the standard format used by healthcare professionals and
suppliers to transmit healthcare claims electronically. The American National Standards
Institute (ANSI) Accredited Standards Committee (ASC) X12N 837P (Professional)
Version 5010A1 is the current electronic claim version. Data elements in the CMS uniform
electronic billing specifications are consistent with the hard copy data set to the extent that
one processing system can handle both.
