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CPT code 96406: Intralesional chemotherapy, more than seven lesions2026 Medicare rate & RVUs in Connecticut

Reports administration of antineoplastic medication directly into more than seven lesions during treatment of multiple localized lesions.

CMS RVU26DEffective Oct 1, 2026One payment locality779 Medicare services in 2024

In Connecticut, Medicare pays $140.84 for 96406 in the office and $39.03 when it’s performed in a hospital or facility.

$140.84Office (non-facility)
$39.03Hospital or facility
+6.8%vs the national office rate ($131.93)

Check a contract rate as a % of Medicare · 96406 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 96406 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 96406 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 96406 covers

This service covers delivery of an antineoplastic medication directly into more than seven discrete lesions. Dermatology and oncology clinicians may perform it in an office or other treatment setting when lesions are treated individually by the intralesional route. The code reflects the number of lesions treated, not the number of injections, syringes, or medications used. It is distinct from systemic chemotherapy delivered by subcutaneous, intramuscular, intravenous, or other routes.

Select the code based on the documented lesion count: this level is for more than seven treated lesions, while 96405 is the lower-count sibling. Record the lesions treated, their sites, the medication, and the intralesional route. The medication is separate from the administration service when separately reportable. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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; assistant-at-surgery payment is restricted, 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 Connecticut compares for 96406

Across 109 of 109 payment localities, the office rate for 96406 runs from $116.41 in Arkansas to $179.56 in San Benito County, CA. Connecticut pays $140.84. The RVUs are the same everywhere; the geographic indexes change the dollars.

96406 in Connecticut vs other payment areas
  1. Connecticut · this page$140.84
  2. Los Angeles, CA · California$151.24+$10.40
  3. Washington, DC area · District of Columbia$151.97+$11.13
  4. Miami, FL · Florida$139.23−$1.61
  5. Chicago, IL · Illinois$135.23−$5.61
  6. Manhattan, NY · New York$151.54+$10.70
  7. Alaska · Alaska$151.10+$10.26

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

Every other payment area

96406 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$118.16$35.45
ArkansasArkansas$116.41$35.21
ArizonaArizona$128.45$36.85
Bakersfield, CACalifornia$141.57$37.97
Chico, CACalifornia$141.37$37.77
El Centro, CACalifornia$141.38$37.78
Fresno, CACalifornia$141.37$37.77
Hanford, CACalifornia$141.37$37.77

96406 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

$116.41

$160.47

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
96406 office rate range by state
State / territoryOffice rate rangeLocalities
AK$151.101
AL$118.161
AR$116.411
AZ$128.451
CA$141.37–$179.5629
CO$138.421
CT$140.841
DC$151.971
DE$130.631
FL$128.40–$139.233
GA$121.17–$134.072
GU$145.231
HI$145.231
IA$121.951
ID$122.621
IL$124.08–$136.454
IN$123.371
KS$121.031
KY$120.311
LA$119.98–$126.122
MA$137.42–$152.832
MD$133.27–$151.973
ME$122.92–$130.272
MI$123.21–$129.702
MN$133.521
MO$117.64–$126.983
MS$117.061
MT$131.931
NC$124.301
ND$130.741
NE$122.741
NH$135.911
NJ$142.69–$150.272
NM$123.771
NV$131.701
NY$126.18–$154.875
OH$122.971
OK$120.441
OR$130.93–$143.302
PA$123.36–$137.032
PR$133.041
RI$135.631
SC$123.791
SD$130.601
TN$121.611
TX$122.50–$137.748
UT$125.541
VA$129.59–$151.972
VI$133.041
VT$129.911
WA$137.27–$156.332
WI$126.211
WV$119.281
WY$131.411

See 96406 in every payment locality

How the 96406 rate is calculated

Each of 96406’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 · 96406

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.80

0.80 RVUs× 1.000 GPCI

Practice expense3.09

3.09 RVUs× 1.000 GPCI

Malpractice0.06

0.06 RVUs× 1.000 GPCI

Adjusted RVUs

3.9500

Conversion factor

$33.4009

Medicare rate

$131.93

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,798

Code
96406
Physician work
0.80
Practice expense
3.09
Malpractice
0.06

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 96406 in Connecticut
ComponentRVULocality factorAdjusted
Physician work0.80× 1.0200.8160
Practice expense3.09× 1.0773.3279
Malpractice0.06× 1.2100.0726
Total RVUs4.2165
Conversion factor× 33.4009

Office rate, Connecticut$140.84

Office: (0.8 × 1.02 + 3.09 × 1.077 + 0.06 × 1.21) × $33.4009 = $140.84

Facility: (0.8 × 1.02 + 0.26 × 1.077 + 0.06 × 1.21) × $33.4009 = $39.03

Open 96406 in the RVU calculator

Payment rules and modifiers for 96406

The CMS indicators that decide how 96406 is paid alongside other services.

CMS payment indicators · 96406

Intralesional chemotherapy, more than seven lesions

RuleCMS valueWhat it means
Global period000Same-day global: pre- and post-op care on the day of the procedure is included.
Multiple procedures2Standard reduction: highest-valued procedure at 100%, others at 50%.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)1Not paid (statutory restriction).
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical0Physician service: no professional/technical split.

What modifiers do to the payment

Modifier 51 · payment effect

With and without the modifier

96406 without 51 · national office

$131.93

Intralesional chemotherapy, more than seven lesions

96406-51 · Second procedure: 50%

$65.97

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%).

When to use modifier 51

Codes related to 96406

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

Codes related to 96406
CodeHow it relatesOffice range, Connecticut
Same family
96405Intralesional chemotherapy, up to seven lesionsIntralesional chemotherapy for seven or fewer lesions.$90.15
Used instead
96401Chemotherapy injection, subcutaneous or intramuscular, nonhormonalAntineoplastic medication administered subcutaneously or intramuscularly rather than into lesions.$77.12
96402Hormonal therapy injection, subcutaneous or intramuscularHormonal antineoplastic medication administered subcutaneously or intramuscularly.$41.46
96409Chemotherapy push, single or initial drugAntineoplastic medication administered by intravenous push rather than intralesionally.$112.40

How 96406 has changed in Connecticut

96406 · Office / nonfacility

$140.84

Effective 2026-10-01

The base rate is $9.43 higher than on 2025-10-01, moving from $131.41 to $140.84 (7.2%).

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

    $131.41changed to$140.84

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.93 changed to 3.09
    • Malpractice RVU 0.04 changed to 0.06
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $139.67changed to$131.41

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.03 changed to 2.93
    • Malpractice RVU 0.06 changed to 0.04

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $137.39changed to$139.67

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $144.37changed to$137.39

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.06 changed to 3.03
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $150.48changed to$144.37

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.10 changed to 3.06
    • Malpractice RVU 0.07 changed to 0.06
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $149.13changed to$150.48

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.05 changed to 3.10
    • Malpractice RVU 0.05 changed to 0.07

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $142.54changed to$149.13

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 2.75 changed to 3.05
    • Malpractice RVU 0.06 changed to 0.05
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $136.35changed to$142.54

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.60 changed to 2.75
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $132.19changed to$136.35

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 2.50 changed to 2.60

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $133.03changed to$132.19

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 2.53 changed to 2.50
    • Malpractice RVU 0.05 changed to 0.06
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $129.47changed to$133.03

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.44 changed to 2.53
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $131.91changed to$129.47

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 2.50 changed to 2.44
    • Malpractice RVU 0.04 changed to 0.05

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $131.25changed to$131.91

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $124.26changed to$131.25

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.33 changed to 2.50
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $129.25changed to$124.26

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.64 changed to 2.33
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $129.25

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$140.84$39.03RVU26D
2026-07-01$140.84$39.03RVU26C
2026-04-01$140.84$39.03RVU26B
2026-01-01$140.84$39.03RVU26A
2025-10-01$131.41$44.95RVU25D
2025-07-01$131.41$44.95RVU25C
2025-04-01$131.41$44.95RVU25B
2025-01-01$131.41$44.95RVU25A
2024-10-01$139.67$46.33RVU24D
2024-07-01$139.67$46.33RVU24C
2024-04-01$139.67$46.33RVU24B
2024-03-09$139.67$46.33RVU24AR
2024-01-01$137.39$45.58RVU24A
2023-10-01$144.37$47.28RVU23D
2023-07-01$144.37$47.28RVU23C
2023-04-01$144.37$47.28RVU23B
2023-01-01$144.37$47.28RVU23A
2022-10-01$150.48$47.93RVU22D
2022-07-01$150.48$47.93RVU22C
2022-04-01$150.48$47.93RVU22B
2022-01-01$150.48$47.93RVU22A
2021-10-01$149.13$48.07RVU21D
2021-07-01$149.13$48.07RVU21C
2021-04-01$149.13$48.07RVU21B
2021-01-01$149.13$48.07RVU21A
2020-10-01$142.54$50.15RVU20D
2020-07-01$142.54$50.15RVU20C
2020-04-01$142.54$50.15RVU20B
2020-01-01$142.54$50.15RVU20A
2019-10-01$136.35$50.18RVU19D
2019-07-01$136.35$50.18RVU19C
2019-04-01$136.35$50.18RVU19B
2019-01-01$136.35$50.18RVU19A
2018-10-01$132.19$50.53RVU18D
2018-07-01$132.19$50.53RVU18C
2018-04-01$132.19$50.53RVU18B
2018-01-01$132.19$50.53RVU18AR1
2017-10-01$133.03$50.44RVU17D
2017-07-01$133.03$50.44RVU17C
2017-04-01$133.03$50.44RVU17B
2017-01-01$133.03$50.44RVU17A
2016-10-01$129.47$50.40RVU16D
2016-07-01$129.47$50.40RVU16C
2016-04-01$129.47$50.40RVU16B
2016-01-01$129.47$50.40RVU16A
2015-10-01$131.91$50.14RVU15D
2015-07-01$131.91$50.14RVU15C
2015-04-01$131.25$49.89RVU15B
2015-01-01$131.25$49.89RVU15A
2014-10-01$124.26$49.50RVU14D
2014-07-01$124.26$49.50RVU14C
2014-04-01$124.26$49.50RVU14B
2014-01-01$124.26$49.50RVU14A
2013-10-01$129.25$48.06RVU13D
2013-07-01$129.25$48.06RVU13C
2013-04-01$129.25$48.06RVU13B
2013-01-01$129.25$48.06RVU13AR

Price 96406 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

96406 billing questions

How is this code distinguished from 96405?

Use this code when more than seven lesions are treated intralesionally. Use 96405 for seven or fewer treated lesions.

Are units based on injections or lesions?

The threshold is based on the number of lesions treated, not the number of needle entries or syringes. Document the treated lesion count and sites.

Is the antineoplastic medication included?

This code reports the administration service, not the medication itself. Report the drug separately when it is separately reportable.

Can modifier 50 be used for lesions on both sides?

No. CMS identifies modifier 50 as inappropriate for this service; treatment of lesions on both sides does not make it a bilateral procedure.

How does the same-session multiple-procedure rule affect payment?

When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.

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 96406PPRRVU2026_Oct_nonQPP.csv, line 12,798 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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