Which CPT Codes are used for billing Ketamine treatment? 

Which CPT Codes are used for billing Ketamine treatment? 

Although we no longer provide coding services for billing Ketamine Treatment, we are certain that you can enjoy timely reimbursements by accurately coding your services, which is why we have compiled for you, a guide on billing for Ketamine treatments. 

The health insurance landscape is ripe for mistakes, misjudgments, and calculations. EMPClaims has always tried to leverage its expertise in area of Revenue Cycle Management so that healthcare becomes simpler for all stakeholders. The following content will help you use the accurate codes for the services provided by your facility for billing ketamine treatment.  

Ketamine Outpatient Billing Codes for billing ketamine treatment

Here we look at two primary HCPCS codes first. 

  • G2082 

Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified healthcare provider and provision of Wag nasal self-administration, includes 2 hours post-administration observation. 

  • G2083 

Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified healthcare provider and provision of WW nasal self-administration, includes 2 hours post-administration observation. 

Outpatient E&M Established Patient  

  • CPT Code 99213 

Description: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a low level of medical decision making.  

Other Ketamine Outpatient Billing Codes 

Notes: Report for IV infusions of 16-90 minutes. 

Add-on Codes for above billing ketamine treatments 

96366: Report for intervals of greater than 30 minutes beyond one-hour increments; also report for secondary or subsequent service after a different initial service through same IV access. 

96367: Report in conjunction with 96365, 96374, 96409, or 96413 if provided as secondary service after a different initial service is administered through the same IV access. Report only once per sequential infusion of same infusate mix (multiple drugs mixed together in one bag is one infusate mix). 

96368: Report in conjunction with codes 96365, 96366, 96413, 96415, or 96416. This is used in case of infusions running simultaneously via the same IV access; which must be hung in separate bags. 

  • CPT Code 93041: Rhythm ECG 1-3 leads J3490 Ketamine, IV
    Description: The CPT Code 93041 is the code used for Medicine / cardiovascular. It is used for tracing of electrical activity of the heart using 1-3 leads for billing ketamine treatments.

Check out the full list of ketamine J codes

  • J2405: Ondansetron HCL Injection 
    Description: HCPCS code for Injection, ondansetron hydrochloride, per 1 mg or just “Ondansetron hcl injection”, in short.  
  • J2765: Metoclopramide HCL Injection 
    Description: HCPCS code J2765 for Injection, metoclopramide HCl, up to 10 mg. 
  • J2250 Injection Midazolam Hydroch 
    Description: J2250 is the HCPCS code for Injection, midazolam hydrochloride, per 1 mg or just “Inj midazolam hydrochloride” in short. 
  • J7030 Infusion Normal Saline 
    Description: J7030 is the HCPCS code for Infusion, normal saline solution, 1000 cc or just “Normal saline solution infus” in short.  
  • 36000 Intro Needle/Intracat
    Description: The Current Procedural Terminology (CPT®) code 36000 as maintained by American Medical Association, is a medical procedural code under the range – Intravenous Vascular Introduction and Injection Procedures. 

Ketamine Inpatient Billing Codes 

  • 99223: Initial Hospital Services Level 3 H&P Day 1 
    Description: 99223 CPT code denotes the highest degree of initial care for patients admitted to the hospital. 

Let us now look at Hospital Consult and Progress Note Day codes for Inpatient billing ketamine treatment and Coding. Understanding and applying these correctly will help you maximize and expedite reimbursement for your billing Ketamine treatment services. 

  • 99255: Level 5 Hospital Consult Day 1 
  • 99255: Level 5 Hospital Consult Day 3 
  • 99255: Level 5 Hospital Consult Day 4 
  • 99255: Level 5 Hospital Consult Day 4 
  • 99255: Level 5 Hospital Consult Day 7 

CPT Code 99255 is described by the CPT manual as follows: “Inpatient consultation for a new or established patient, requiring three key components for billing ketamine treatments: 

  • Medical decision-making of high complexity. 
  • A comprehensive examination. 
  • A comprehensive history. 
  • 99252 Level 2 Hospital Consult Day 4 
  • 99252 Level 2 Hospital Consult Day 5 
  • 99252 Level 2 Hospital Consult Day 5 
  • 99233 Level 3 Progress Note Day 2 
  • 99222 Level 3 Progress Note Day 3 
  • 99233 Level 3 Progress Note Day 5 
  • 99233 Level 3 Progress Note Day 6 

Note: The 99233 represents the highest level of care for hospital progress notes.  

  • CPT Code 96360: Intravenous infusion, hydration; initial, 31 minutes to 1 hour Day 1 
    Description: The provider introduces a catheter intravenously for supplementation of fluid and electrolytes for 31 minutes to one hour to treat severe cases of dehydration. 
  • CPT Code 99295: Initial Inpatient, Intensive Care Unit, Room& Board, Incidentals Day 1 
  • CPT Code: 76499 Chest X-Ray Reading Day 2  
    Description: Code 76499 as maintained by American Medical Association, is a medical procedural code under the range – Other Diagnostic Radiology (Diagnostic Imaging) Related Procedures. 
  • CPT Code 96361: Intravenous infusion, hydration; each additional hour, day 1-7.  
    Description: Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) 

Note: Report for intervals of greater than 30 minutes beyond one-hour increments; also report for secondary or subsequent service after a different initial service through same IV access for billing ketamine treatments. 

  • CPT Code 90774: Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug Day 1-7 
  • J3490: Unclassified drug (use for Ketamine) Day 1-7 

J3490 is a valid 2023 HCPCS code for Unclassified drugs or just “Drugs unclassified injection” for short. 

We may not take on your Ketamine Billing treatments and Coding but what we do provide is a well- rounded Revenue Cycle Management for your practice. To check out our Clinical Specialties and Solutions visit our website or get in touch with us right away for more details on various billing ketamine treatments. 

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