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CPT 96372 Modifier Decision Matrix (2026) Does CPT 96372 Need a Modifier

Kamlin COF, T MJ, J LH, N SA

Ward, P

List price is set by a pharmaceutical company, and in many cases is what uninsured diabetics pay Net price is the actual profit the company receives for a drug Rebates are discounts on drugs negotiated for insurance companies Co-payments are what an insured person pays for a prescription, out-of-pocket Deductibles , which can be as high as $10,000, are what insurance policies say must be paid before the insurer picks up the rest Insurance companies enlist third-party negotiators, called pharmacy benefit managers, to fix discounts with drug manufacturers that in turn result in smaller co-payment prices for their users

CoA-LOT: BN221129/CA

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