CPT/HCPCS Codes
Group 1 Paragraph: N/A
Group 1 Codes:
96360Hydration iv infusion init
96361Hydrate iv infusion add-on
Coverage Indications, Limitations, and/or Medical Necessity
Indications
The clinical manifestations of dehydration or volume depletion are related to the volume and rate of fluid loss, the nature of the fluid that is lost, and the responsiveness of the vasculature to volume reduction. Rehydration with fluids containing sodium as the principal solute preferentially expands the extracellular fluid volume; a 1-liter infusion of normal saline may expand blood volume by about 300 ml. In general, an imbalance of less than 500 ml of volume is not likely to require intravenous rehydration.
Hydration services are indicated:
In documented volume depletion.
When performed in conjunction with chemotherapy, these CPT codes are covered only when infusion is prolonged and done sequentially [done hour(s) before and/or after administration of chemotherapy], and when the volume status of a patient is compromised or will be compromised by side effects of chemotherapy or an illness.
In some endocrine conditions with findings such as hypercalcemia, prolonged hydration can be medically necessary.
As an adjunct to the treatment of hypotension.
Limitations
Rehydration with the administration of an amount of fluid equal to or less than 500 ml is not reasonable and necessary.
These CPT codes are not to be used for routine IV drug injections.
Hanging of D5W or other fluid just prior to administration of chemotherapy is not hydration therapy and should not be billed with these codes.
When the sole purpose of fluid administration is to maintain patency of the access device, these infusion CPT codes should not be billed as hydration therapy.
Administration of fluid in the course of transfusions to maintain line patency or between units of blood product is not to be separately billed as hydration therapy.
Fluid used to administer drug(s) is incidental hydration and is not separately payable.
Rehydration via hydration therapy of extensively dehydrated patients can be accomplished in hours; therefore, the medical necessity of hydration beyond 12 hours must be documented in the medical record.
These CPT codes require the direct supervision of the physician or non-physician practitioner for the initiation of the service.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
N/A
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
N/A
ICD-10 Codes that Support Medical Necessity
ICD-10 CODEDESCRIPTION
E11.649 - E11.69 - Opens in a new windowType 2 diabetes mellitus with hypoglycemia without coma - Type 2 diabetes mellitus with other specified complication
E13.649 - E13.69 - Opens in a new windowOther specified diabetes mellitus with hypoglycemia without coma - Other
specified diabetes mellitus with other specified complication
E83.52Hypercalcemia
E86.0 - E87.0 - Opens in a new windowDehydration - Hyperosmolality and hypernatremia
I95.9Hypotension, unspecified
K29.00 - K29.91 - Opens in a new windowAcute gastritis without bleeding - Gastroduodenitis, unspecified, with bleeding
K52.89 - K52.9 - Opens in a new windowOther specified noninfective gastroenteritis and colitis - Noninfective
gastroenteritis and colitis, unspecified
K92.0Hematemesis
N18.3Chronic kidney disease, stage 3 (moderate)
O21.1 - O21.8 - Opens in a new windowHyperemesis gravidarum with metabolic disturbance - Other vomiting complicating
pregnancy
R11.10 - R11.12 - Opens in a new windowVomiting, unspecified - Projectile vomiting
R11.2Nausea with vomiting, unspecified
R19.7Diarrhea, unspecified
R41.0Disorientation, unspecified
R41.82Altered mental status, unspecified
R42Dizziness and giddiness
R55Syncope and collapse
Z51.11Encounter for antineoplastic chemotherapy
Z91.89Other specified personal risk factors, not elsewhere classified
Group 1 Paragraph: N/A
Group 1 Codes:
96360Hydration iv infusion init
96361Hydrate iv infusion add-on
Coverage Indications, Limitations, and/or Medical Necessity
Indications
The clinical manifestations of dehydration or volume depletion are related to the volume and rate of fluid loss, the nature of the fluid that is lost, and the responsiveness of the vasculature to volume reduction. Rehydration with fluids containing sodium as the principal solute preferentially expands the extracellular fluid volume; a 1-liter infusion of normal saline may expand blood volume by about 300 ml. In general, an imbalance of less than 500 ml of volume is not likely to require intravenous rehydration.
Hydration services are indicated:
In documented volume depletion.
When performed in conjunction with chemotherapy, these CPT codes are covered only when infusion is prolonged and done sequentially [done hour(s) before and/or after administration of chemotherapy], and when the volume status of a patient is compromised or will be compromised by side effects of chemotherapy or an illness.
In some endocrine conditions with findings such as hypercalcemia, prolonged hydration can be medically necessary.
As an adjunct to the treatment of hypotension.
Limitations
Rehydration with the administration of an amount of fluid equal to or less than 500 ml is not reasonable and necessary.
These CPT codes are not to be used for routine IV drug injections.
Hanging of D5W or other fluid just prior to administration of chemotherapy is not hydration therapy and should not be billed with these codes.
When the sole purpose of fluid administration is to maintain patency of the access device, these infusion CPT codes should not be billed as hydration therapy.
Administration of fluid in the course of transfusions to maintain line patency or between units of blood product is not to be separately billed as hydration therapy.
Fluid used to administer drug(s) is incidental hydration and is not separately payable.
Rehydration via hydration therapy of extensively dehydrated patients can be accomplished in hours; therefore, the medical necessity of hydration beyond 12 hours must be documented in the medical record.
These CPT codes require the direct supervision of the physician or non-physician practitioner for the initiation of the service.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
N/A
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
N/A
ICD-10 Codes that Support Medical Necessity
ICD-10 CODEDESCRIPTION
E11.649 - E11.69 - Opens in a new windowType 2 diabetes mellitus with hypoglycemia without coma - Type 2 diabetes mellitus with other specified complication
E13.649 - E13.69 - Opens in a new windowOther specified diabetes mellitus with hypoglycemia without coma - Other
specified diabetes mellitus with other specified complication
E83.52Hypercalcemia
E86.0 - E87.0 - Opens in a new windowDehydration - Hyperosmolality and hypernatremia
I95.9Hypotension, unspecified
K29.00 - K29.91 - Opens in a new windowAcute gastritis without bleeding - Gastroduodenitis, unspecified, with bleeding
K52.89 - K52.9 - Opens in a new windowOther specified noninfective gastroenteritis and colitis - Noninfective
gastroenteritis and colitis, unspecified
K92.0Hematemesis
N18.3Chronic kidney disease, stage 3 (moderate)
O21.1 - O21.8 - Opens in a new windowHyperemesis gravidarum with metabolic disturbance - Other vomiting complicating
pregnancy
R11.10 - R11.12 - Opens in a new windowVomiting, unspecified - Projectile vomiting
R11.2Nausea with vomiting, unspecified
R19.7Diarrhea, unspecified
R41.0Disorientation, unspecified
R41.82Altered mental status, unspecified
R42Dizziness and giddiness
R55Syncope and collapse
Z51.11Encounter for antineoplastic chemotherapy
Z91.89Other specified personal risk factors, not elsewhere classified