CPT code 96405: Intralesional chemotherapy, up to seven lesions2026 Medicare rate & RVUs in Montana
Report 96405 when an antineoplastic drug is administered directly into one to seven lesions, such as in a dermatology or oncology setting.
In Montana, Medicare pays $84.50 for 96405 in the office and $23.71 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 96405 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 96405 covers
A physician or other qualified practitioner reports 96405 for administering chemotherapy directly into one or more lesions, with the code covering up to seven lesions. This is a local injection into the lesions, rather than systemic chemotherapy given subcutaneously, intramuscularly, or intravenously. Dermatology and oncology practices commonly provide this service for selected cutaneous lesions; the code represents the administration, not the drug product.
Document the antineoplastic agent, intralesional route, treated sites, and lesion count. Use the code for one through seven lesions; when more than seven are treated, compare the service with 96406. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
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 Montana compares for 96405
Across 109 of 109 payment localities, the office rate for 96405 runs from $74.69 in Arkansas to $115.18 in San Benito County, CA. Montana pays $84.50. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Montana · this page$84.50
- Los Angeles, CA · California$96.98+$12.48
- Washington, DC area · District of Columbia$97.33+$12.83
- Miami, FL · Florida$88.75+$4.25
- Chicago, IL · Illinois$86.25+$1.75
- Manhattan, NY · New York$96.92+$12.42
- Alaska · Alaska$97.04+$12.54
Other areas in Montana first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $75.80 | $22.61 |
| ArkansasArkansas | $74.69 | $22.48 |
| ArizonaArizona | $82.31 | $23.40 |
| Bakersfield, CACalifornia | $90.79 | $24.17 |
| Chico, CACalifornia | $90.68 | $24.06 |
| El Centro, CACalifornia | $90.69 | $24.06 |
| Fresno, CACalifornia | $90.68 | $24.06 |
| Hanford, CACalifornia | $90.68 | $24.06 |
| Madera, CACalifornia | $90.68 | $24.06 |
| Merced, CACalifornia | $90.68 | $24.06 |
| Modesto, CACalifornia | $90.68 | $24.06 |
| Napa, CACalifornia | $106.14 | $26.02 |
| Oxnard, CACalifornia | $96.65 | $24.80 |
| Redding, CACalifornia | $90.68 | $24.06 |
| Rest of CaliforniaCalifornia | $90.68 | $24.06 |
| Riverside, CACalifornia | $91.02 | $24.39 |
| Sacramento, CACalifornia | $95.44 | $24.75 |
| Salinas, CACalifornia | $95.09 | $24.64 |
| San Diego, CACalifornia | $97.53 | $24.82 |
| Marin County, CACalifornia | $112.73 | $27.01 |
| San Francisco, CACalifornia | $112.69 | $26.98 |
| San Benito County, CACalifornia | $115.18 | $27.52 |
| Santa Clara County, CACalifornia | $115.04 | $27.38 |
| San Luis Obispo, CACalifornia | $93.53 | $24.29 |
| Santa Cruz, CACalifornia | $98.62 | $24.76 |
| Santa Maria, CACalifornia | $95.50 | $24.62 |
| Santa Rosa, CACalifornia | $99.64 | $24.99 |
| Stockton, CACalifornia | $90.68 | $24.06 |
| Vallejo, CACalifornia | $106.09 | $25.97 |
| Visalia, CACalifornia | $90.68 | $24.06 |
| Yuba City, CACalifornia | $90.68 | $24.06 |
| ColoradoColorado | $88.73 | $24.05 |
| ConnecticutConnecticut | $90.15 | $24.68 |
| DelawareDelaware | $83.70 | $23.64 |
| Fort Lauderdale, FLFlorida | $86.17 | $24.59 |
| Rest of FloridaFlorida | $82.10 | $23.98 |
| Atlanta, GAGeorgia | $85.82 | $24.05 |
| Rest of GeorgiaGeorgia | $77.55 | $23.33 |
| Hawaii, Guam, HIHawaii | $93.14 | $24.02 |
| IowaIowa | $78.28 | $22.66 |
| IdahoIdaho | $78.69 | $22.76 |
| East St. Louis, ILIllinois | $80.23 | $24.30 |
| Rest of IllinoisIllinois | $79.31 | $23.81 |
| Suburban Chicago, ILIllinois | $87.19 | $24.75 |
| IndianaIndiana | $79.16 | $22.81 |
| KansasKansas | $77.66 | $22.70 |
| KentuckyKentucky | $77.08 | $23.04 |
| New Orleans, LALouisiana | $80.74 | $23.54 |
| Rest of LouisianaLouisiana | $76.86 | $23.06 |
| Metropolitan Boston, MAMassachusetts | $97.94 | $25.35 |
| Rest of MassachusettsMassachusetts | $88.08 | $24.07 |
| Baltimore area, MDMaryland | $89.85 | $24.62 |
| Rest of MarylandMaryland | $85.39 | $23.87 |
| Rest of MaineMaine | $78.83 | $22.91 |
| Southern Maine, MEMaine | $83.54 | $23.30 |
| Detroit, MIMichigan | $82.88 | $24.21 |
| Rest of MichiganMichigan | $78.88 | $23.38 |
| MinnesotaMinnesota | $85.72 | $23.16 |
| Metropolitan Kansas City, MOMissouri | $80.45 | $23.37 |
| Metropolitan St. Louis, MOMissouri | $81.33 | $23.46 |
| Rest of MissouriMissouri | $75.35 | $22.95 |
| MississippiMississippi | $75.05 | $22.71 |
| North CarolinaNorth Carolina | $79.71 | $22.99 |
| North DakotaNorth Dakota | $83.91 | $23.12 |
| NebraskaNebraska | $78.79 | $22.68 |
| New HampshireNew Hampshire | $87.09 | $23.81 |
| Northern New JerseyNew Jersey | $96.25 | $25.73 |
| Rest of New JerseyNew Jersey | $91.38 | $25.00 |
| New MexicoNew Mexico | $79.22 | $23.47 |
| NevadaNevada | $84.40 | $23.55 |
| NYC suburbs and Long Island, NYNew York | $98.97 | $26.70 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $91.78 | $25.21 |
| Queens, NYNew York | $98.10 | $26.24 |
| Rest of New YorkNew York | $80.90 | $23.15 |
| OhioOhio | $78.76 | $23.26 |
| OklahomaOklahoma | $77.20 | $22.92 |
| Portland, OROregon | $91.87 | $24.33 |
| Rest of OregonOregon | $83.94 | $23.40 |
| Metropolitan Philadelphia, PAPennsylvania | $87.72 | $24.44 |
| Rest of PennsylvaniaPennsylvania | $79.03 | $23.22 |
| Puerto RicoPuerto Rico | $85.22 | $23.76 |
| Rhode IslandRhode Island | $86.91 | $24.11 |
| South CarolinaSouth Carolina | $79.33 | $23.16 |
| South DakotaSouth Dakota | $83.84 | $23.05 |
| TennesseeTennessee | $78.02 | $22.76 |
| Austin, TXTexas | $88.26 | $23.95 |
| Beaumont, TXTexas | $78.48 | $23.16 |
| Brazoria, TXTexas | $83.83 | $23.59 |
| Dallas, TXTexas | $84.25 | $23.71 |
| Fort Worth, TXTexas | $83.61 | $23.67 |
| Galveston, TXTexas | $84.01 | $23.64 |
| Houston, TXTexas | $84.56 | $24.19 |
| Rest of TexasTexas | $81.03 | $23.34 |
| UtahUtah | $80.43 | $23.29 |
| VirginiaVirginia | $83.09 | $23.33 |
| Virgin Islands, VIUnited States Virgin Islands | $85.22 | $23.76 |
| VermontVermont | $83.35 | $23.17 |
| Rest of WashingtonWashington | $88.00 | $23.98 |
| King County, WAWashington | $100.20 | $25.61 |
| WisconsinWisconsin | $81.03 | $22.80 |
| West VirginiaWest Virginia | $76.27 | $23.45 |
| WyomingWyoming | $84.24 | $23.45 |
96405 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.
$74.69
$102.93
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 | $97.04 | 1 |
| AL | $75.80 | 1 |
| AR | $74.69 | 1 |
| AZ | $82.31 | 1 |
| CA | $90.68–$115.18 | 29 |
| CO | $88.73 | 1 |
| CT | $90.15 | 1 |
| DC | $97.33 | 1 |
| DE | $83.70 | 1 |
| FL | $82.10–$88.75 | 3 |
| GA | $77.55–$85.82 | 2 |
| GU | $93.14 | 1 |
| HI | $93.14 | 1 |
| IA | $78.28 | 1 |
| ID | $78.69 | 1 |
| IL | $79.31–$87.19 | 4 |
| IN | $79.16 | 1 |
| KS | $77.66 | 1 |
| KY | $77.08 | 1 |
| LA | $76.86–$80.74 | 2 |
| MA | $88.08–$97.94 | 2 |
| MD | $85.39–$97.33 | 3 |
| ME | $78.83–$83.54 | 2 |
| MI | $78.88–$82.88 | 2 |
| MN | $85.72 | 1 |
| MO | $75.35–$81.33 | 3 |
| MS | $75.05 | 1 |
| MT | $84.50 | 1 |
| NC | $79.71 | 1 |
| ND | $83.91 | 1 |
| NE | $78.79 | 1 |
| NH | $87.09 | 1 |
| NJ | $91.38–$96.25 | 2 |
| NM | $79.22 | 1 |
| NV | $84.40 | 1 |
| NY | $80.90–$98.97 | 5 |
| OH | $78.76 | 1 |
| OK | $77.20 | 1 |
| OR | $83.94–$91.87 | 2 |
| PA | $79.03–$87.72 | 2 |
| PR | $85.22 | 1 |
| RI | $86.91 | 1 |
| SC | $79.33 | 1 |
| SD | $83.84 | 1 |
| TN | $78.02 | 1 |
| TX | $78.48–$88.26 | 8 |
| UT | $80.43 | 1 |
| VA | $83.09–$97.33 | 2 |
| VI | $85.22 | 1 |
| VT | $83.35 | 1 |
| WA | $88.00–$100.20 | 2 |
| WI | $81.03 | 1 |
| WV | $76.27 | 1 |
| WY | $84.24 | 1 |
How the 96405 rate is calculated
Each of 96405’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 · 96405
RVUs × geographic indexes × conversion factor
Work0.52
0.52 RVUs× 1.000 GPCI
Practice expense1.98
1.98 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
2.5300
Conversion factor
$33.4009
Medicare rate
$84.50
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Montana inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,797
- Code
- 96405
- Physician work
- 0.52
- Practice expense
- 1.98
- Malpractice
- 0.03
GPCI2026.csv
71
- Locality
- Montana
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.998
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.52 | × 1.000 | 0.5200 |
| Practice expense | 1.98 | × 1.000 | 1.9800 |
| Malpractice | 0.03 | × 0.998 | 0.0299 |
| Total RVUs | 2.5299 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Montana$84.50
Office: (0.52 × 1 + 1.98 × 1 + 0.03 × 0.998) × $33.4009 = $84.50
Facility: (0.52 × 1 + 0.16 × 1 + 0.03 × 0.998) × $33.4009 = $23.71
Payment rules and modifiers for 96405
The CMS indicators that decide how 96405 is paid alongside other services.
CMS payment indicators · 96405
Intralesional chemotherapy, up to seven lesions
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
96405 without 51 · national office
$84.50
Intralesional chemotherapy, up to seven lesions
96405-51 · Second procedure: 50%
$42.25
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
How 96405 has changed in Montana
96405 · Office / nonfacility
$84.50
Effective 2026-10-01
The base rate is $4.95 higher than on 2025-10-01, moving from $79.55 to $84.50 (6.2%).
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
$79.55changed to$84.50
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.91 changed to 1.98
- Malpractice GPCI 0.978 changed to 0.998
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$82.86changed to$79.55
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.94 changed to 1.91
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$81.51changed to$82.86
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$85.03changed to$81.51
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.95 changed to 1.94
- Malpractice RVU 0.04 changed to 0.03
January 1, 2023
RVU23A
$86.83changed to$85.03
- Conversion factor 34.6062 changed to 33.8872
- Malpractice GPCI 0.977 changed to 0.978
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$87.55changed to$86.83
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$85.14changed to$87.55
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.80 changed to 1.95
- Malpractice RVU 0.03 changed to 0.04
- Malpractice GPCI 1.304 changed to 0.977
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$83.93changed to$85.14
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.76 changed to 1.80
- Malpractice GPCI 1.631 changed to 1.304
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$83.12changed to$83.93
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.74 changed to 1.76
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$83.36changed to$83.12
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.76 changed to 1.74
- Malpractice GPCI 1.429 changed to 1.631
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$82.95changed to$83.36
- Conversion factor 35.8043 changed to 35.8887
- Malpractice GPCI 1.226 changed to 1.429
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$82.81changed to$82.95
- Conversion factor 35.9335 changed to 35.8043
- Malpractice RVU 0.02 changed to 0.03
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$82.40changed to$82.81
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$81.50changed to$82.40
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 1.72 changed to 1.76
- Malpractice RVU 0.03 changed to 0.02
- Malpractice GPCI 1.165 changed to 1.226
Held through RVU15B.
January 1, 2014
RVU14A
$84.14changed to$81.50
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 1.92 changed to 1.72
- Malpractice GPCI 1.103 changed to 1.165
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $84.14
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $84.50 | $23.71 | RVU26D |
| 2026-07-01 | $84.50 | $23.71 | RVU26C |
| 2026-04-01 | $84.50 | $23.71 | RVU26B |
| 2026-01-01 | $84.50 | $23.71 | RVU26A |
| 2025-10-01 | $79.55 | $27.80 | RVU25D |
| 2025-07-01 | $79.55 | $27.80 | RVU25C |
| 2025-04-01 | $79.55 | $27.80 | RVU25B |
| 2025-01-01 | $79.55 | $27.80 | RVU25A |
| 2024-10-01 | $82.86 | $28.27 | RVU24D |
| 2024-07-01 | $82.86 | $28.27 | RVU24C |
| 2024-04-01 | $82.86 | $28.27 | RVU24B |
| 2024-03-09 | $82.86 | $28.27 | RVU24AR |
| 2024-01-01 | $81.51 | $27.81 | RVU24A |
| 2023-10-01 | $85.03 | $29.11 | RVU23D |
| 2023-07-01 | $85.03 | $29.11 | RVU23C |
| 2023-04-01 | $85.03 | $29.11 | RVU23B |
| 2023-01-01 | $85.03 | $29.11 | RVU23A |
| 2022-10-01 | $86.83 | $29.04 | RVU22D |
| 2022-07-01 | $86.83 | $29.04 | RVU22C |
| 2022-04-01 | $86.83 | $29.04 | RVU22B |
| 2022-01-01 | $86.83 | $29.04 | RVU22A |
| 2021-10-01 | $87.55 | $29.28 | RVU21D |
| 2021-07-01 | $87.55 | $29.28 | RVU21C |
| 2021-04-01 | $87.55 | $29.28 | RVU21B |
| 2021-01-01 | $87.55 | $29.28 | RVU21A |
| 2020-10-01 | $85.14 | $30.64 | RVU20D |
| 2020-07-01 | $85.14 | $30.64 | RVU20C |
| 2020-04-01 | $85.14 | $30.64 | RVU20B |
| 2020-01-01 | $85.14 | $30.64 | RVU20A |
| 2019-10-01 | $83.93 | $30.96 | RVU19D |
| 2019-07-01 | $83.93 | $30.96 | RVU19C |
| 2019-04-01 | $83.93 | $30.96 | RVU19B |
| 2019-01-01 | $83.93 | $30.96 | RVU19A |
| 2018-10-01 | $83.12 | $31.28 | RVU18D |
| 2018-07-01 | $83.12 | $31.28 | RVU18C |
| 2018-04-01 | $83.12 | $31.28 | RVU18B |
| 2018-01-01 | $83.12 | $31.28 | RVU18AR1 |
| 2017-10-01 | $83.36 | $31.33 | RVU17D |
| 2017-07-01 | $83.36 | $31.33 | RVU17C |
| 2017-04-01 | $83.36 | $31.33 | RVU17B |
| 2017-01-01 | $83.36 | $31.33 | RVU17A |
| 2016-10-01 | $82.95 | $30.68 | RVU16D |
| 2016-07-01 | $82.95 | $30.68 | RVU16C |
| 2016-04-01 | $82.95 | $30.68 | RVU16B |
| 2016-01-01 | $82.95 | $30.68 | RVU16A |
| 2015-10-01 | $82.81 | $30.35 | RVU15D |
| 2015-07-01 | $82.81 | $30.35 | RVU15C |
| 2015-04-01 | $82.40 | $30.20 | RVU15B |
| 2015-01-01 | $82.40 | $30.20 | RVU15A |
| 2014-10-01 | $81.50 | $30.63 | RVU14D |
| 2014-07-01 | $81.50 | $30.63 | RVU14C |
| 2014-04-01 | $81.50 | $30.63 | RVU14B |
| 2014-01-01 | $81.50 | $30.63 | RVU14A |
| 2013-10-01 | $84.14 | $30.05 | RVU13D |
| 2013-07-01 | $84.14 | $30.05 | RVU13C |
| 2013-04-01 | $84.14 | $30.05 | RVU13B |
| 2013-01-01 | $84.14 | $30.05 | RVU13AR |
Where the Montana rate applies
Montana is a Medicare payment area, not a city. Our Census mapping connects it to 497 cities and communities in Montana. Some span more than one payment area; confirm with the service ZIP.
- Absarokee
- Acton
- Alberton
- Alder
- Alzada
- Amsterdam
- Anaconda-Deer Lodge County
- Antelope
96405 billing questions
How many lesions can be reported with 96405?
96405 covers administration into one through seven lesions. For treatment of more than seven lesions, compare the service with 96406 rather than reporting 96405 for every lesion.
How is 96405 different from 11900?
96405 is for intralesional chemotherapy. Code 11900 is for intralesional injection of a substance other than chemotherapy, for up to seven lesions.
Is the chemotherapy drug included in 96405?
No. The code represents administration; report a separately payable drug product under its applicable code when the practice supplies it and documentation supports separate reporting.
Should modifier 50 be used when lesions are on both sides?
No. CMS identifies bilateral adjustment as inappropriate for 96405. Report the service based on the number of treated lesions, not as a bilateral procedure.
What documentation supports 96405?
Record the drug, intralesional route, lesion locations, and number of lesions treated. The count supports choosing 96405 for up to seven lesions or 96406 for more than seven.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction. CMS does not pay an assistant at surgery for 96405.
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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