CPT code 96401: Chemotherapy injection, subcutaneous or intramuscular, nonhormonal2026 Medicare rate & RVUs in South Dakota

Report 96401 when a qualifying nonhormonal antineoplastic drug, such as bortezomib or azacitidine, is administered by subcutaneous or intramuscular injection.

CMS RVU26DEffective Oct 1, 2026One payment locality937.5K Medicare services in 2024

In South Dakota, Medicare pays $70.92 for 96401 in the office.

$70.92Office (non-facility)
Not available in this settingHospital or facility
−1.2%vs the national office rate ($71.81)

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.

We’ll open 96401 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in South Dakota
  2. What 96401 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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 South Dakota 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. South Dakota pays $70.92. The RVUs are the same everywhere; the geographic indexes change the dollars.

96401 in South Dakota vs other payment areas
  1. South Dakota · this page$70.92
  2. Los Angeles, CA · California$83.26+$12.34
  3. Washington, DC area · District of Columbia$83.64+$12.72
  4. Miami, FL · Florida$76.46+$5.54
  5. Chicago, IL · Illinois$73.91+$2.99
  6. Manhattan, NY · New York$83.32+$12.40
  7. Alaska · Alaska$78.84+$7.92

Other areas in South Dakota first, then benchmark localities. Bars start at $0.

Every other payment area

96401 in every other Medicare payment locality
Payment localityOfficeFacility
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—

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
96401 office rate range by state
State / territoryOffice rate rangeLocalities
AK$78.841
AL$63.301
AR$62.221
AZ$69.651
CA$77.40–$100.0129
CO$75.671
CT$77.121
DC$83.641
DE$70.951
FL$69.69–$76.463
GA$65.21–$73.122
GU$79.941
HI$79.941
IA$65.611
ID$66.031
IL$67.04–$74.614
IN$66.491
KS$65.061
KY$64.651
LA$64.46–$68.252
MA$75.02–$84.262
MD$72.53–$83.643
ME$66.23–$70.752
MI$66.46–$70.512
MN$72.711
MO$63.02–$68.773
MS$62.641
MT$71.811
NC$67.081
ND$71.021
NE$66.091
NH$74.251
NJ$78.06–$82.502
NM$66.811
NV$71.651
NY$68.24–$85.405
OH$66.301
OK$64.721
OR$71.16–$78.632
PA$66.53–$74.802
PR$72.491
RI$73.901
SC$66.791
SD$70.921
TN$65.421
TX$66.01–$75.358
UT$67.871
VA$70.34–$83.642
VI$72.491
VT$70.521
WA$74.95–$86.322
WI$68.221
WV$64.071
WY$71.461

See 96401 in every payment locality

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

Office or facility?

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 South Dakota 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

94

Locality
South Dakota
Physician work
1.000
Practice expense
1.000
Malpractice
0.336
Office calculation for 96401 in South Dakota
ComponentRVULocality factorAdjusted
Physician work0.21× 1.0000.2100
Practice expense1.90× 1.0001.9000
Malpractice0.04× 0.3360.0134
Total RVUs2.1234
Conversion factor× 33.4009

Office rate, South Dakota$70.92

Office: (0.21 × 1 + 1.9 × 1 + 0.04 × 0.336) × $33.4009 = $70.92

Open 96401 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical5Incident-to service.

How 96401 has changed in South Dakota

96401 · Office / nonfacility

$70.92

Effective 2026-10-01

The base rate is $5.41 higher than on 2025-10-01, moving from $65.51 to $70.92 (8.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

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
  1. January 1, 2026

    RVU26A

    $65.51changed to$70.92

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 1.80 changed to 1.90
    • Malpractice GPCI 0.382 changed to 0.336

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $70.75changed to$65.51

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 1.90 changed to 1.80

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $69.59changed to$70.75

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $72.67changed to$69.59

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 1.92 changed to 1.90
    • Malpractice GPCI 0.364 changed to 0.382
  5. January 1, 2023

    RVU23A

    $76.73changed to$72.67

    • 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
    • Malpractice GPCI 0.347 changed to 0.364

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $81.21changed to$76.73

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 2.10 changed to 1.99

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $78.98changed to$81.21

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.96 changed to 2.10
    • Malpractice GPCI 0.368 changed to 0.347

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $79.63changed to$78.98

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.98 changed to 1.96
    • Malpractice GPCI 0.389 changed to 0.368

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $80.62changed to$79.63

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.01 changed to 1.98

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $74.28changed to$80.62

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.84 changed to 2.01
    • Malpractice GPCI 0.395 changed to 0.389

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $74.11changed to$74.28

    • Conversion factor 35.8043 changed to 35.8887
    • Malpractice GPCI 0.400 changed to 0.395

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $74.60changed to$74.11

    • 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.

  13. July 1, 2015

    RVU15C

    $74.23changed to$74.60

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $72.96changed to$74.23

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.81 changed to 1.85
    • Malpractice GPCI 0.416 changed to 0.400

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $75.10changed to$72.96

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.98 changed to 1.81
    • Malpractice GPCI 0.432 changed to 0.416

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $75.10

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$70.92Not available in this settingRVU26D
2026-07-01$70.92Not available in this settingRVU26C
2026-04-01$70.92Not available in this settingRVU26B
2026-01-01$70.92Not available in this settingRVU26A
2025-10-01$65.51Not available in this settingRVU25D
2025-07-01$65.51Not available in this settingRVU25C
2025-04-01$65.51Not available in this settingRVU25B
2025-01-01$65.51Not available in this settingRVU25A
2024-10-01$70.75Not available in this settingRVU24D
2024-07-01$70.75Not available in this settingRVU24C
2024-04-01$70.75Not available in this settingRVU24B
2024-03-09$70.75Not available in this settingRVU24AR
2024-01-01$69.59Not available in this settingRVU24A
2023-10-01$72.67Not available in this settingRVU23D
2023-07-01$72.67Not available in this settingRVU23C
2023-04-01$72.67Not available in this settingRVU23B
2023-01-01$72.67Not available in this settingRVU23A
2022-10-01$76.73Not available in this settingRVU22D
2022-07-01$76.73Not available in this settingRVU22C
2022-04-01$76.73Not available in this settingRVU22B
2022-01-01$76.73Not available in this settingRVU22A
2021-10-01$81.21Not available in this settingRVU21D
2021-07-01$81.21Not available in this settingRVU21C
2021-04-01$81.21Not available in this settingRVU21B
2021-01-01$81.21Not available in this settingRVU21A
2020-10-01$78.98Not available in this settingRVU20D
2020-07-01$78.98Not available in this settingRVU20C
2020-04-01$78.98Not available in this settingRVU20B
2020-01-01$78.98Not available in this settingRVU20A
2019-10-01$79.63Not available in this settingRVU19D
2019-07-01$79.63Not available in this settingRVU19C
2019-04-01$79.63Not available in this settingRVU19B
2019-01-01$79.63Not available in this settingRVU19A
2018-10-01$80.62Not available in this settingRVU18D
2018-07-01$80.62Not available in this settingRVU18C
2018-04-01$80.62Not available in this settingRVU18B
2018-01-01$80.62Not available in this settingRVU18AR1
2017-10-01$74.28Not available in this settingRVU17D
2017-07-01$74.28Not available in this settingRVU17C
2017-04-01$74.28Not available in this settingRVU17B
2017-01-01$74.28Not available in this settingRVU17A
2016-10-01$74.11Not available in this settingRVU16D
2016-07-01$74.11Not available in this settingRVU16C
2016-04-01$74.11Not available in this settingRVU16B
2016-01-01$74.11Not available in this settingRVU16A
2015-10-01$74.60Not available in this settingRVU15D
2015-07-01$74.60Not available in this settingRVU15C
2015-04-01$74.23Not available in this settingRVU15B
2015-01-01$74.23Not available in this settingRVU15A
2014-10-01$72.96Not available in this settingRVU14D
2014-07-01$72.96Not available in this settingRVU14C
2014-04-01$72.96Not available in this settingRVU14B
2014-01-01$72.96Not available in this settingRVU14A
2013-10-01$75.10Not available in this settingRVU13D
2013-07-01$75.10Not available in this settingRVU13C
2013-04-01$75.10Not available in this settingRVU13B
2013-01-01$75.10Not available in this settingRVU13AR

Price 96401 for an earlier date of service

Where the South Dakota rate applies

South Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 485 cities and communities in South Dakota. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Agar
  • Agency Village
  • Akaska
  • Albee
  • Alcester
  • Alexandria
  • Allen

Browse all communities in South Dakota

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
RVUs for 96401PPRRVU2026_Oct_nonQPP.csv, line 12,795 (RVU26D)
Geographic factors for South DakotaGPCI2026.csv, line 94 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 96401 pays in South Dakota?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 96401 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist