CPT code 96413: Chemo IV infusion, initial drug, first hour2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $134.57 for 96413 in the office.

Check a contract rate as a % of Medicare · 96413 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 96413 covers

Code 96413 captures the initial hour of an intravenous antineoplastic infusion or an infusion of another agent that meets chemotherapy administration requirements for high-complexity biologic therapy. Oncology nurses commonly administer these treatments in physician offices or outpatient infusion suites under an oncologist’s or hematologist’s supervision. Paclitaxel or carboplatin infusions are familiar examples. Nursing work includes preparing the infusion, assessing the patient, monitoring for reactions, and ending the infusion; classification as a monoclonal antibody alone does not establish eligibility for chemotherapy administration coding.

Report one initial administration service per encounter unless separate medically necessary IV sites support distinct initial services. Record the drug and actual start and stop times; infusion lasting more than 15 minutes supports 96413, and 96415 begins only when the infusion exceeds 90 minutes. Sequential chemotherapy drugs and separately administered premedications or hydration may support additional administration codes when their requirements are met. The IV start, routine flush, and usual supplies are included; report separately payable drug products with appropriate HCPCS codes. CMS classifies 96413 as an incident-to service, billed only when performed under physician supervision.

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 96413

Across 109 of 109 payment localities, the office rate for 96413 runs from $114.99 in Arkansas to $186.95 in San Benito County, CA. Puerto Rico pays $134.57. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

96413 rates by state

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

See 96413 in every payment locality

How the 96413 rate is calculated

Each of 96413’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 96413

The CMS indicators that decide how 96413 is paid alongside other services.

Codes related to 96413

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

How 96413 has changed in Puerto Rico

Price 96413 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