E&M 99214 + Injection 96372
Office E&M 99214 (moderate complexity) and 96372 (therapeutic injection) bundle unless modifier 25 is appended.
Why this pair bundles
Same policy as 99213/96372 — the routine pre-injection assessment is bundled into 96372. Modifier 25 required to report the E&M separately.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Append modifier 25 to the E&M when documentation supports a significant, separately identifiable evaluation.
Documentation requirements
- Separate chief complaint addressed
- Distinct MDM elements
- Note that supports moderate-complexity work beyond the injection prep
Common clinical scenarios
- Established patient with multiple chronic conditions receiving routine injection plus E&M for medication adjustments
Frequently asked questions
Why does CMS bundle 99214 and 96372?
Same policy as 99213/96372 — the routine pre-injection assessment is bundled into 96372. Modifier 25 required to report the E&M separately.
When can I use modifier 59 (or X{EPSU}) to bypass?
Append modifier 25 to the E&M when documentation supports a significant, separately identifiable evaluation.
What documentation supports separate billing?
Separate chief complaint addressed; Distinct MDM elements; Note that supports moderate-complexity work beyond the injection prep.
When does this conflict typically arise?
Established patient with multiple chronic conditions receiving routine injection plus E&M for medication adjustments.
Related NCCI edits
Sources
Catch NCCI 99214/96372 conflicts before submission
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