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

In Puerto Rico, Medicare pays $133.04 for 96406 in the office and $37.47 when it’s performed in a hospital or facility.

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.

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 Puerto Rico 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. Puerto Rico pays $133.04. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

96406 rates by state

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

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.

Payment rules and modifiers for 96406

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

What modifiers do to the payment

When to use modifier 51

Codes related to 96406

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

How 96406 has changed in Puerto Rico

Price 96406 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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