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Section 1847A(i)(5) of the Act requires that for Part B rebatable drugs, as defined in section 1847A(i)(2)(A) of the Act, furnished on or after April 1, 2023, in quarters in which the payment amount described in section 1847A(i)(3)(A)(ii)(I) of the Act (or, in the case of selected drugs described under section 1192(c) of the Act, the payment amount described in section 1847A(b)(1)(B) of the Act), exceeds the inflation-adjusted payment amount determined in accordance with section 1847A(i)(3)(C) of the Act, the coinsurance will be 20 percent of the inflation-adjusted payment amount for such quarter (hereafter, the inflation-adjusted coinsurance amount)

Common Billing Challenges with CPT 96372 Why Claims Get Denied Billing errors often occur due to: Missing or incomplete documentation Using the wrong CPT modifier Diagnosis codes that do not clearly justify the injection How to Avoid Errors Include detailed documentation, including the providers order and injection details Ensure the diagnosis code matches the injection purpose Follow payer-specific rules for claim submission Proper documentation and coding reduce denials, speed up reimbursements, and keep your revenue cycle healthy

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