CPT code 96405: Intralesional chemotherapy, up to seven lesions2026 Medicare rate & RVUs in Virginia

In Virginia, Medicare pays $83.09 for 96405 in the office and $23.33 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.

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 Virginia 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. Virginia pays $83.09. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

96405 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 96405 in every payment locality

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.

Payment rules and modifiers for 96405

The CMS indicators that decide how 96405 is paid alongside other services.

What modifiers do to the payment

When to use modifier 51

Codes related to 96405

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 96405 has changed in Virginia

Price 96405 for an earlier date of service

Where the Virginia rate applies

Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 628 cities and communities in Virginia. Some span more than one payment area; confirm with the service ZIP.

• Abbs Valley
• Abingdon
• Accomac
• Adwolf
• Afton
• Alberta
• Aldie
• Allison Gap

Browse all communities in Virginia

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

Open CMS sourceHow we calculate rates