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June 27, 2025

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When billing CPT code 96372, ensure the following are included in the medical record: Name and dosage of the drug administered Route of administration (subcutaneous or intramuscular) Site of injection Time and date of service Reason for the injection (diagnosis or medical necessity) Signature and credentials of the administering provider Accurate and complete documentation supports the claim, validates medical necessity, and helps protect against audits and reimbursement issues