CPT code 96401: Chemotherapy injection, subcutaneous or intramuscular, nonhormonal2026 Medicare rate & RVUs in Puerto Rico
Report 96401 when a qualifying nonhormonal antineoplastic drug, such as bortezomib or azacitidine, is administered by subcutaneous or intramuscular injection.
In Puerto Rico, Medicare pays $72.49 for 96401 in the office.
Check a contract rate as a % of Medicare · 96401 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 96401 covers
Trained oncology staff administer nonhormonal antineoplastic medication beneath the skin or into muscle, most often in a physician's oncology or hematology office. Examples include subcutaneous bortezomib for multiple myeloma and azacitidine for myelodysplastic syndromes; qualifying subcutaneous antibody formulations include daratumumab with hyaluronidase. Nursing work includes verifying the agent and dose, administering the injection, and monitoring the patient for a reaction.
Choose 96401 for qualifying subcutaneous or intramuscular nonhormonal antineoplastic administration, rather than hormonal injections under 96402 or routine therapeutic injections under 96372. The administration is separate from the drug supply, which is reported with its appropriate HCPCS code and documented dose. Record the medication, dose, route, injection site, date, and supervising physician. CMS classifies 96401 as an incident-to service; billing under the physician requires physician supervision. A significant, separately identifiable E/M service may be reported with modifier 25 on the E/M code when documentation supports work beyond the injection encounter.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
How Puerto Rico compares for 96401
Across 109 of 109 payment localities, the office rate for 96401 runs from $62.22 in Arkansas to $100.01 in San Benito County, CA. Puerto Rico pays $72.49. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$72.49
- Los Angeles, CA · California$83.26+$10.77
- Washington, DC area · District of Columbia$83.64+$11.15
- Miami, FL · Florida$76.46+$3.97
- Chicago, IL · Illinois$73.91+$1.42
- Manhattan, NY · New York$83.32+$10.83
- Alaska · Alaska$78.84+$6.35
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $63.30 | — |
| ArkansasArkansas | $62.22 | — |
| ArizonaArizona | $69.65 | — |
| Bakersfield, CACalifornia | $77.52 | — |
| Chico, CACalifornia | $77.40 | — |
| El Centro, CACalifornia | $77.41 | — |
| Fresno, CACalifornia | $77.40 | — |
| Hanford, CACalifornia | $77.40 | — |
| Madera, CACalifornia | $77.40 | — |
| Merced, CACalifornia | $77.40 | — |
| Modesto, CACalifornia | $77.40 | — |
| Napa, CACalifornia | $91.78 | — |
| Oxnard, CACalifornia | $83.05 | — |
| Redding, CACalifornia | $77.40 | — |
| Rest of CaliforniaCalifornia | $77.40 | — |
| Riverside, CACalifornia | $77.83 | — |
| Sacramento, CACalifornia | $81.79 | — |
| Salinas, CACalifornia | $81.50 | — |
| San Diego, CACalifornia | $83.85 | — |
| Marin County, CACalifornia | $97.77 | — |
| San Francisco, CACalifornia | $97.73 | — |
| San Benito County, CACalifornia | $100.01 | — |
| Santa Clara County, CACalifornia | $99.83 | — |
| San Luis Obispo, CACalifornia | $80.13 | — |
| Santa Cruz, CACalifornia | $84.98 | — |
| Santa Maria, CACalifornia | $81.92 | — |
| Santa Rosa, CACalifornia | $85.87 | — |
| Stockton, CACalifornia | $77.40 | — |
| Vallejo, CACalifornia | $91.71 | — |
| Visalia, CACalifornia | $77.40 | — |
| Yuba City, CACalifornia | $77.40 | — |
| ColoradoColorado | $75.67 | — |
| ConnecticutConnecticut | $77.12 | — |
| DelawareDelaware | $70.95 | — |
| Fort Lauderdale, FLFlorida | $73.72 | — |
| Rest of FloridaFlorida | $69.69 | — |
| Atlanta, GAGeorgia | $73.12 | — |
| Rest of GeorgiaGeorgia | $65.21 | — |
| Hawaii, Guam, HIHawaii | $79.94 | — |
| IowaIowa | $65.61 | — |
| IdahoIdaho | $66.03 | — |
| East St. Louis, ILIllinois | $68.09 | — |
| Rest of IllinoisIllinois | $67.04 | — |
| Suburban Chicago, ILIllinois | $74.61 | — |
| IndianaIndiana | $66.49 | — |
| KansasKansas | $65.06 | — |
| KentuckyKentucky | $64.65 | — |
| New Orleans, LALouisiana | $68.25 | — |
| Rest of LouisianaLouisiana | $64.46 | — |
| Metropolitan Boston, MAMassachusetts | $84.26 | — |
| Rest of MassachusettsMassachusetts | $75.02 | — |
| Baltimore area, MDMaryland | $76.87 | — |
| Rest of MarylandMaryland | $72.53 | — |
| Rest of MaineMaine | $66.23 | — |
| Southern Maine, MEMaine | $70.75 | — |
| Detroit, MIMichigan | $70.51 | — |
| Rest of MichiganMichigan | $66.46 | — |
| MinnesotaMinnesota | $72.71 | — |
| Metropolitan Kansas City, MOMissouri | $67.91 | — |
| Metropolitan St. Louis, MOMissouri | $68.77 | — |
| Rest of MissouriMissouri | $63.02 | — |
| MississippiMississippi | $62.64 | — |
| MontanaMontana | $71.81 | — |
| North CarolinaNorth Carolina | $67.08 | — |
| North DakotaNorth Dakota | $71.02 | — |
| NebraskaNebraska | $66.09 | — |
| New HampshireNew Hampshire | $74.25 | — |
| Northern New JerseyNew Jersey | $82.50 | — |
| Rest of New JerseyNew Jersey | $78.06 | — |
| New MexicoNew Mexico | $66.81 | — |
| NevadaNevada | $71.65 | — |
| NYC suburbs and Long Island, NYNew York | $85.40 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $78.44 | — |
| Queens, NYNew York | $84.40 | — |
| Rest of New YorkNew York | $68.24 | — |
| OhioOhio | $66.30 | — |
| OklahomaOklahoma | $64.72 | — |
| Portland, OROregon | $78.63 | — |
| Rest of OregonOregon | $71.16 | — |
| Metropolitan Philadelphia, PAPennsylvania | $74.80 | — |
| Rest of PennsylvaniaPennsylvania | $66.53 | — |
| Rhode IslandRhode Island | $73.90 | — |
| South CarolinaSouth Carolina | $66.79 | — |
| South DakotaSouth Dakota | $70.92 | — |
| TennesseeTennessee | $65.42 | — |
| Austin, TXTexas | $75.35 | — |
| Beaumont, TXTexas | $66.01 | — |
| Brazoria, TXTexas | $71.00 | — |
| Dallas, TXTexas | $71.43 | — |
| Fort Worth, TXTexas | $70.81 | — |
| Galveston, TXTexas | $71.19 | — |
| Houston, TXTexas | $71.93 | — |
| Rest of TexasTexas | $68.45 | — |
| UtahUtah | $67.87 | — |
| VirginiaVirginia | $70.34 | — |
| Virgin Islands, VIUnited States Virgin Islands | $72.49 | — |
| VermontVermont | $70.52 | — |
| Rest of WashingtonWashington | $74.95 | — |
| King County, WAWashington | $86.32 | — |
| WisconsinWisconsin | $68.22 | — |
| West VirginiaWest Virginia | $64.07 | — |
| WyomingWyoming | $71.46 | — |
96401 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$62.22
$88.71
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $78.84 | 1 |
| AL | $63.30 | 1 |
| AR | $62.22 | 1 |
| AZ | $69.65 | 1 |
| CA | $77.40–$100.01 | 29 |
| CO | $75.67 | 1 |
| CT | $77.12 | 1 |
| DC | $83.64 | 1 |
| DE | $70.95 | 1 |
| FL | $69.69–$76.46 | 3 |
| GA | $65.21–$73.12 | 2 |
| GU | $79.94 | 1 |
| HI | $79.94 | 1 |
| IA | $65.61 | 1 |
| ID | $66.03 | 1 |
| IL | $67.04–$74.61 | 4 |
| IN | $66.49 | 1 |
| KS | $65.06 | 1 |
| KY | $64.65 | 1 |
| LA | $64.46–$68.25 | 2 |
| MA | $75.02–$84.26 | 2 |
| MD | $72.53–$83.64 | 3 |
| ME | $66.23–$70.75 | 2 |
| MI | $66.46–$70.51 | 2 |
| MN | $72.71 | 1 |
| MO | $63.02–$68.77 | 3 |
| MS | $62.64 | 1 |
| MT | $71.81 | 1 |
| NC | $67.08 | 1 |
| ND | $71.02 | 1 |
| NE | $66.09 | 1 |
| NH | $74.25 | 1 |
| NJ | $78.06–$82.50 | 2 |
| NM | $66.81 | 1 |
| NV | $71.65 | 1 |
| NY | $68.24–$85.40 | 5 |
| OH | $66.30 | 1 |
| OK | $64.72 | 1 |
| OR | $71.16–$78.63 | 2 |
| PA | $66.53–$74.80 | 2 |
| PR | $72.49 | 1 |
| RI | $73.90 | 1 |
| SC | $66.79 | 1 |
| SD | $70.92 | 1 |
| TN | $65.42 | 1 |
| TX | $66.01–$75.35 | 8 |
| UT | $67.87 | 1 |
| VA | $70.34–$83.64 | 2 |
| VI | $72.49 | 1 |
| VT | $70.52 | 1 |
| WA | $74.95–$86.32 | 2 |
| WI | $68.22 | 1 |
| WV | $64.07 | 1 |
| WY | $71.46 | 1 |
How the 96401 rate is calculated
Each of 96401’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 96401
RVUs × geographic indexes × conversion factor
Work0.21
0.21 RVUs× 1.000 GPCI
Practice expense1.90
1.90 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
2.1500
Conversion factor
$33.4009
Medicare rate
$71.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,795
- Code
- 96401
- Physician work
- 0.21
- Practice expense
- 1.90
- Malpractice
- 0.04
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.21 | × 1.000 | 0.2100 |
| Practice expense | 1.90 | × 1.011 | 1.9209 |
| Malpractice | 0.04 | × 0.985 | 0.0394 |
| Total RVUs | 2.1703 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$72.49
Office: (0.21 × 1 + 1.9 × 1.011 + 0.04 × 0.985) × $33.4009 = $72.49
Payment rules and modifiers for 96401
The CMS indicators that decide how 96401 is paid alongside other services.
CMS payment indicators · 96401
Chemotherapy injection, subcutaneous or intramuscular, nonhormonal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
How 96401 has changed in Puerto Rico
96401 · Office / nonfacility
$72.49
Effective 2026-10-01
The base rate is $5.80 higher than on 2025-10-01, moving from $66.69 to $72.49 (8.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$66.69changed to$72.49
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.80 changed to 1.90
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$71.99changed to$66.69
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.90 changed to 1.80
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$70.81changed to$71.99
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$74.03changed to$70.81
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.92 changed to 1.90
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$73.54changed to$74.03
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$78.39changed to$73.54
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.99 changed to 1.92
- Malpractice RVU 0.05 changed to 0.04
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
$82.91changed to$78.39
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 2.10 changed to 1.99
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$80.66changed to$82.91
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.96 changed to 2.10
- Malpractice GPCI 0.988 changed to 0.986
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$81.21changed to$80.66
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.98 changed to 1.96
- Practice expense GPCI 1.007 changed to 1.008
- Malpractice GPCI 0.990 changed to 0.988
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$82.21changed to$81.21
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 2.01 changed to 1.98
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$65.21changed to$82.21
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.84 changed to 2.01
- Practice expense GPCI 0.856 changed to 1.007
- Malpractice GPCI 0.642 changed to 0.990
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$54.49changed to$65.21
- Conversion factor 35.8043 changed to 35.8887
- Practice expense GPCI 0.705 changed to 0.856
- Malpractice GPCI 0.293 changed to 0.642
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$54.83changed to$54.49
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 1.85 changed to 1.84
- Malpractice RVU 0.04 changed to 0.05
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$54.56changed to$54.83
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$52.78changed to$54.56
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.81 changed to 1.85
- Practice expense GPCI 0.692 changed to 0.705
- Malpractice GPCI 0.271 changed to 0.293
Held through RVU15B.
January 1, 2014
RVU14A
$53.16changed to$52.78
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.98 changed to 1.81
- Practice expense GPCI 0.678 changed to 0.692
- Malpractice GPCI 0.249 changed to 0.271
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $53.16
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $72.49 | Not available in this setting | RVU26D |
| 2026-07-01 | $72.49 | Not available in this setting | RVU26C |
| 2026-04-01 | $72.49 | Not available in this setting | RVU26B |
| 2026-01-01 | $72.49 | Not available in this setting | RVU26A |
| 2025-10-01 | $66.69 | Not available in this setting | RVU25D |
| 2025-07-01 | $66.69 | Not available in this setting | RVU25C |
| 2025-04-01 | $66.69 | Not available in this setting | RVU25B |
| 2025-01-01 | $66.69 | Not available in this setting | RVU25A |
| 2024-10-01 | $71.99 | Not available in this setting | RVU24D |
| 2024-07-01 | $71.99 | Not available in this setting | RVU24C |
| 2024-04-01 | $71.99 | Not available in this setting | RVU24B |
| 2024-03-09 | $71.99 | Not available in this setting | RVU24AR |
| 2024-01-01 | $70.81 | Not available in this setting | RVU24A |
| 2023-10-01 | $74.03 | Not available in this setting | RVU23D |
| 2023-07-01 | $73.54 | Not available in this setting | RVU23C |
| 2023-04-01 | $73.54 | Not available in this setting | RVU23B |
| 2023-01-01 | $73.54 | Not available in this setting | RVU23A |
| 2022-10-01 | $78.39 | Not available in this setting | RVU22D |
| 2022-07-01 | $78.39 | Not available in this setting | RVU22C |
| 2022-04-01 | $78.39 | Not available in this setting | RVU22B |
| 2022-01-01 | $78.39 | Not available in this setting | RVU22A |
| 2021-10-01 | $82.91 | Not available in this setting | RVU21D |
| 2021-07-01 | $82.91 | Not available in this setting | RVU21C |
| 2021-04-01 | $82.91 | Not available in this setting | RVU21B |
| 2021-01-01 | $82.91 | Not available in this setting | RVU21A |
| 2020-10-01 | $80.66 | Not available in this setting | RVU20D |
| 2020-07-01 | $80.66 | Not available in this setting | RVU20C |
| 2020-04-01 | $80.66 | Not available in this setting | RVU20B |
| 2020-01-01 | $80.66 | Not available in this setting | RVU20A |
| 2019-10-01 | $81.21 | Not available in this setting | RVU19D |
| 2019-07-01 | $81.21 | Not available in this setting | RVU19C |
| 2019-04-01 | $81.21 | Not available in this setting | RVU19B |
| 2019-01-01 | $81.21 | Not available in this setting | RVU19A |
| 2018-10-01 | $82.21 | Not available in this setting | RVU18D |
| 2018-07-01 | $82.21 | Not available in this setting | RVU18C |
| 2018-04-01 | $82.21 | Not available in this setting | RVU18B |
| 2018-01-01 | $82.21 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $65.21 | Not available in this setting | RVU17D |
| 2017-07-01 | $65.21 | Not available in this setting | RVU17C |
| 2017-04-01 | $65.21 | Not available in this setting | RVU17B |
| 2017-01-01 | $65.21 | Not available in this setting | RVU17A |
| 2016-10-01 | $54.49 | Not available in this setting | RVU16D |
| 2016-07-01 | $54.49 | Not available in this setting | RVU16C |
| 2016-04-01 | $54.49 | Not available in this setting | RVU16B |
| 2016-01-01 | $54.49 | Not available in this setting | RVU16A |
| 2015-10-01 | $54.83 | Not available in this setting | RVU15D |
| 2015-07-01 | $54.83 | Not available in this setting | RVU15C |
| 2015-04-01 | $54.56 | Not available in this setting | RVU15B |
| 2015-01-01 | $54.56 | Not available in this setting | RVU15A |
| 2014-10-01 | $52.78 | Not available in this setting | RVU14D |
| 2014-07-01 | $52.78 | Not available in this setting | RVU14C |
| 2014-04-01 | $52.78 | Not available in this setting | RVU14B |
| 2014-01-01 | $52.78 | Not available in this setting | RVU14A |
| 2013-10-01 | $53.16 | Not available in this setting | RVU13D |
| 2013-07-01 | $53.16 | Not available in this setting | RVU13C |
| 2013-04-01 | $53.16 | Not available in this setting | RVU13B |
| 2013-01-01 | $53.16 | Not available in this setting | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
96401 billing questions
When is 96402 reported instead of 96401?
Use 96402 when the injected antineoplastic is hormonal, such as leuprolide, goserelin, or fulvestrant. Nonhormonal agents such as bortezomib or azacitidine are reported with 96401 when administered subcutaneously or intramuscularly.
Can 96401 be used for methotrexate given to a rheumatoid arthritis patient?
Methotrexate and a rheumatoid arthritis diagnosis alone do not establish chemotherapy administration. A routine subcutaneous or intramuscular therapeutic injection is reported with 96372; use 96401 only when the service qualifies as chemotherapy administration.
Is the drug included in 96401?
No. Report the drug separately with its applicable HCPCS code, such as J9041 for bortezomib or J9025 for azacitidine, using units supported by the documented dose.
Can an E/M visit be billed on the same day?
A significant, separately identifiable E/M service may be reported when documentation supports work beyond the injection encounter; append modifier 25 to the E/M code. Do not separately report a nurse-only 99211 visit for the chemotherapy administration.
What supervision is required in the office?
CMS classifies 96401 as an incident-to service. The injection must be performed under physician supervision to be billed under the physician.
When does 96372 apply instead of 96401?
Use 96372 for a routine subcutaneous or intramuscular therapeutic injection, such as vitamin B12, ceftriaxone, or methotrexate given for rheumatoid arthritis. Use 96401 when the nonhormonal injection qualifies as chemotherapy administration.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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