What infusion therapies are common in neurology?
Neurology practices administer a range of infusion therapies: disease-modifying therapies for multiple sclerosis (natalizumab, ocrelizumab, alemtuzumab, ofatumumab), treatments for myasthenia gravis (eculizumab, efgartigimod, intravenous immunoglobulin, plasmapheresis), migraine preventive therapies (eptinezumab), and treatments for neuromyelitis optica spectrum disorder and other autoimmune neurological conditions.
Each therapy has distinct dosing intervals, administration time requirements, safety monitoring requirements, and payer-specific authorization processes. The billing requirements for these services differ substantially from office visit billing and require familiarity with infusion CPT codes and the administrative processes specific to specialty drug administration.
What CPT codes apply to neurology infusions?
Infusion billing uses the therapeutic/prophylactic/diagnostic infusion hierarchy (96365–96368, 96374–96376) for drug administration. The primary infusion code (96365) covers the first hour, with sequential hourly add-on codes (96366) for each additional hour. Concurrent infusions (96368) and intravenous pushes (96374) may be billed when administered separately.
The drug itself is billed separately using HCPCS J-codes specific to each medication: J2323 for natalizumab, J9034 for ocrelizumab, J0221 for alemtuzumab, and so on. Drug billing requires documentation of the exact administered dose in the units specified by the code.
Documentation errors — missing start/stop times, incorrect dose recording, or failure to document all concurrent services — are the most common sources of infusion claim denials.
What documentation do neurology infusions require?
Complete infusion documentation includes: the clinical indication and diagnosis; the specific drug, formulation, and dose ordered and administered; the route of administration; infusion start and stop times (essential for time-based billing); any pre-medications and their administration times; the patient's vital signs monitoring during infusion; the supervising physician's identity; and any adverse events or reactions during the infusion.
Prior to the infusion visit, documentation must establish medical necessity through the treating neurologist's notes — the diagnosis, the severity of disease, prior treatment history, and the clinical rationale for the infusion therapy. This documentation is the foundation of the prior authorization package and must be current and specific.
Post-infusion, the patient's response must be documented, particularly for therapies with known infusion reactions or monitoring requirements (natalizumab JC antibody status, alemtuzumab CBC monitoring).
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