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

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 Queens, NY, Medicare pays $153.31 for 96406 in the office and $41.59 when it’s performed in a hospital or facility.

$153.31Office (non-facility)
$41.59Hospital or facility
+16.2%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 Queens, NY
  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 Queens, NY 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. Queens, NY pays $153.31. The RVUs are the same everywhere; the geographic indexes change the dollars.

96406 in Queens, NY vs other payment areas
  1. Queens, NY · this page$153.31
  2. Manhattan, NY · New York$151.54−$1.77
  3. NYC suburbs and Long Island, NY · New York$154.87+$1.56
  4. Poughkeepsie and northern NYC suburbs, NY · New York$143.36−$9.95
  5. Rest of New York · New York$126.18−$27.13
  6. Los Angeles, CA · California$151.24−$2.07
  7. Washington, DC area · District of Columbia$151.97−$1.34

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

Every other payment area

96406 in every other Medicare payment locality
Payment localityOfficeFacility
Miami, FLFlorida$139.23$40.83
Chicago, ILIllinois$135.23$40.23
AlaskaAlaska$151.10$50.43
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

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 Queens, NY 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

81

Locality
Queens, NY
Physician work
1.064
Practice expense
1.182
Malpractice
1.442
Office calculation for 96406 in Queens, NY
ComponentRVULocality factorAdjusted
Physician work0.80× 1.0640.8512
Practice expense3.09× 1.1823.6524
Malpractice0.06× 1.4420.0865
Total RVUs4.5901
Conversion factor× 33.4009

Office rate, Queens, NY$153.31

Office: (0.8 × 1.064 + 3.09 × 1.182 + 0.06 × 1.442) × $33.4009 = $153.31

Facility: (0.8 × 1.064 + 0.26 × 1.182 + 0.06 × 1.442) × $33.4009 = $41.59

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, Queens, NY
Same family
96405Intralesional chemotherapy, up to seven lesionsIntralesional chemotherapy for seven or fewer lesions.$98.10
Used instead
96401Chemotherapy injection, subcutaneous or intramuscular, nonhormonalAntineoplastic medication administered subcutaneously or intramuscularly rather than into lesions.$84.40
96402Hormonal therapy injection, subcutaneous or intramuscularHormonal antineoplastic medication administered subcutaneously or intramuscularly.$45.22
96409Chemotherapy push, single or initial drugAntineoplastic medication administered by intravenous push rather than intralesionally.$123.15

How 96406 has changed in Queens, NY

96406 · Office / nonfacility

$153.31

Effective 2026-10-01

The base rate is $10.60 higher than on 2025-10-01, moving from $142.71 to $153.31 (7.4%).

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

    $142.71changed to$153.31

    • 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 1.065 changed to 1.064
    • Practice expense GPCI 1.195 changed to 1.182
    • Malpractice GPCI 1.462 changed to 1.442

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $151.81changed to$142.71

    • 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

    $149.33changed to$151.81

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $158.63changed to$149.33

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.06 changed to 3.03
    • Work GPCI 1.061 changed to 1.065
    • Practice expense GPCI 1.212 changed to 1.195
    • Malpractice GPCI 2.061 changed to 1.462

  5. January 1, 2023

    RVU23A

    $167.42changed to$158.63

    • 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 1.056 changed to 1.061
    • Practice expense GPCI 1.228 changed to 1.212
    • Malpractice GPCI 2.661 changed to 2.061

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $164.81changed to$167.42

    • 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

    $156.09changed to$164.81

    • 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 1.054 changed to 1.056
    • Practice expense GPCI 1.214 changed to 1.228
    • Malpractice GPCI 2.391 changed to 2.661

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $147.36changed to$156.09

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 2.60 changed to 2.75
    • Work GPCI 1.052 changed to 1.054
    • Practice expense GPCI 1.200 changed to 1.214
    • Malpractice GPCI 2.121 changed to 2.391

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $142.88changed to$147.36

    • 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

    $143.02changed to$142.88

    • 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
    • Malpractice GPCI 2.151 changed to 2.121

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $138.78changed to$143.02

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 2.44 changed to 2.53
    • Practice expense GPCI 1.199 changed to 1.200
    • Malpractice GPCI 2.181 changed to 2.151

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $141.09changed to$138.78

    • 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

    $140.39changed to$141.09

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $132.83changed to$140.39

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 2.33 changed to 2.50
    • Work GPCI 1.057 changed to 1.052
    • Practice expense GPCI 1.197 changed to 1.199
    • Malpractice GPCI 1.836 changed to 2.181

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $138.27changed to$132.83

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 2.64 changed to 2.33
    • Work GPCI 1.062 changed to 1.057
    • Practice expense GPCI 1.195 changed to 1.197
    • Malpractice GPCI 1.491 changed to 1.836

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $138.27

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$153.31$41.59RVU26D
2026-07-01$153.31$41.59RVU26C
2026-04-01$153.31$41.59RVU26B
2026-01-01$153.31$41.59RVU26A
2025-10-01$142.71$48.00RVU25D
2025-07-01$142.71$48.00RVU25C
2025-04-01$142.71$48.00RVU25B
2025-01-01$142.71$48.00RVU25A
2024-10-01$151.81$49.58RVU24D
2024-07-01$151.81$49.58RVU24C
2024-04-01$151.81$49.58RVU24B
2024-03-09$151.81$49.58RVU24AR
2024-01-01$149.33$48.77RVU24A
2023-10-01$158.63$51.85RVU23D
2023-07-01$158.63$51.85RVU23C
2023-04-01$158.63$51.85RVU23B
2023-01-01$158.63$51.85RVU23A
2022-10-01$167.42$54.38RVU22D
2022-07-01$167.42$54.38RVU22C
2022-04-01$167.42$54.38RVU22B
2022-01-01$167.42$54.38RVU22A
2021-10-01$164.81$53.40RVU21D
2021-07-01$164.81$53.40RVU21C
2021-04-01$164.81$53.40RVU21B
2021-01-01$164.81$53.40RVU21A
2020-10-01$156.09$55.32RVU20D
2020-07-01$156.09$55.32RVU20C
2020-04-01$156.09$55.32RVU20B
2020-01-01$156.09$55.32RVU20A
2019-10-01$147.36$54.38RVU19D
2019-07-01$147.36$54.38RVU19C
2019-04-01$147.36$54.38RVU19B
2019-01-01$147.36$54.38RVU19A
2018-10-01$142.88$54.75RVU18D
2018-07-01$142.88$54.75RVU18C
2018-04-01$142.88$54.75RVU18B
2018-01-01$142.88$54.75RVU18AR1
2017-10-01$143.02$54.30RVU17D
2017-07-01$143.02$54.30RVU17C
2017-04-01$143.02$54.30RVU17B
2017-01-01$143.02$54.30RVU17A
2016-10-01$138.78$54.21RVU16D
2016-07-01$138.78$54.21RVU16C
2016-04-01$138.78$54.21RVU16B
2016-01-01$138.78$54.21RVU16A
2015-10-01$141.09$53.63RVU15D
2015-07-01$141.09$53.63RVU15C
2015-04-01$140.39$53.36RVU15B
2015-01-01$140.39$53.36RVU15A
2014-10-01$132.83$52.65RVU14D
2014-07-01$132.83$52.65RVU14C
2014-04-01$132.83$52.65RVU14B
2014-01-01$132.83$52.65RVU14A
2013-10-01$138.27$50.86RVU13D
2013-07-01$138.27$50.86RVU13C
2013-04-01$138.27$50.86RVU13B
2013-01-01$138.27$50.86RVU13AR

Price 96406 for an earlier date of service

Where the Queens, NY rate applies

Queens, NY is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in New York. Some span more than one payment area; confirm with the service ZIP.

Browse all communities in New York

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 Queens, NYGPCI2026.csv, line 81 (RVU26D)

Open CMS sourceHow we calculate rates

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