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CPT code 96416: Pump infusion, prolonged infusion over eight hours2026 Medicare rate & RVUs in Washington, DC area

Reports initiation of intravenous chemotherapy delivered for more than eight hours through a portable or implantable pump.

CMS RVU26DEffective Oct 1, 2026One payment locality23K Medicare services in 2024

In Washington, DC area, Medicare pays $155.97 for 96416 in the office.

$155.97Office (non-facility)
Not available in this settingHospital or facility
+17.0%vs the national office rate ($133.27)

Check a contract rate as a % of Medicare · 96416 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 96416 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Washington, DC area
  2. What 96416 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 96416 covers

This service covers starting an intravenous chemotherapy infusion intended to continue for more than eight hours using a portable or implantable pump. It is commonly initiated by oncology staff in an office infusion clinic, with the patient continuing the infusion outside the clinic. The pump may be portable or implanted; the defining features are the prolonged infusion and pump-based delivery.

Report 96416 for starting the qualifying infusion, not for each hour the pump continues to deliver medication. Documentation should identify the chemotherapy drug, intravenous route, pump use, and infusion duration, and support that the service was initiated. The chemotherapy drug is reported separately when applicable. CMS treats this as an incident-to service: it may be 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 Washington, DC area compares for 96416

Across 109 of 109 payment localities, the office rate for 96416 runs from $114.66 in Arkansas to $187.73 in San Benito County, CA. Washington, DC area pays $155.97. The RVUs are the same everywhere; the geographic indexes change the dollars.

96416 in Washington, DC area vs other payment areas
  1. Washington, DC area · this page$155.97
  2. Los Angeles, CA · California$155.45−$0.52
  3. Miami, FL · Florida$141.93−$14.04
  4. Chicago, IL · Illinois$136.97−$19.00
  5. Manhattan, NY · New York$155.16−$0.81
  6. Alaska · Alaska$143.78−$12.19
  7. Alabama · Alabama$116.77−$39.20

Other areas in District of Columbia first, then benchmark localities. Bars start at $0.

Every other payment area

96416 in every other Medicare payment locality
Payment localityOfficeFacility
ArkansasArkansas$114.66—
ArizonaArizona$129.09—
Bakersfield, CACalifornia$144.38—
Chico, CACalifornia$144.20—
El Centro, CACalifornia$144.21—
Fresno, CACalifornia$144.20—
Hanford, CACalifornia$144.20—
Madera, CACalifornia$144.20—

96416 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.

$114.66

$165.96

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

View every state and territory as a table
96416 office rate range by state
State / territoryOffice rate rangeLocalities
AK$143.781
AL$116.771
AR$114.661
AZ$129.091
CA$144.20–$187.7329
CO$140.771
CT$143.441
DC$155.971
DE$131.581
FL$128.99–$141.933
GA$120.34–$135.742
GU$149.261
HI$149.261
IA$121.331
ID$122.121
IL$123.81–$138.474
IN$123.021
KS$120.211
KY$119.321
LA$118.92–$126.282
MA$139.47–$157.342
MD$134.64–$155.973
ME$122.47–$131.292
MI$122.79–$130.542
MN$135.221
MO$116.11–$127.333
MS$115.431
MT$133.261
NC$124.121
ND$131.881
NE$122.271
NH$138.061
NJ$145.18–$153.702
NM$123.451
NV$133.001
NY$126.38–$159.145
OH$122.511
OK$119.491
OR$132.08–$146.542
PA$122.98–$138.932
PR$134.601
RI$137.241
SC$123.501
SD$131.721
TN$120.911
TX$121.95–$140.208
UT$125.601
VA$130.48–$155.972
VI$134.601
VT$130.881
WA$139.37–$161.322
WI$126.451
WV$118.041
WY$132.661

See 96416 in every payment locality

How the 96416 rate is calculated

Each of 96416’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 · 96416

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.21

0.21 RVUs× 1.000 GPCI

Practice expense3.71

3.71 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

3.9900

Conversion factor

$33.4009

Medicare rate

$133.27

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

The exact Washington, DC area inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,803

Code
96416
Physician work
0.21
Practice expense
3.71
Malpractice
0.07

GPCI2026.csv

39

Locality
Washington, DC area
Physician work
1.054
Practice expense
1.178
Malpractice
1.113
Office calculation for 96416 in Washington, DC area
ComponentRVULocality factorAdjusted
Physician work0.21× 1.0540.2213
Practice expense3.71× 1.1784.3704
Malpractice0.07× 1.1130.0779
Total RVUs4.6696
Conversion factor× 33.4009

Office rate, Washington, DC area$155.97

Office: (0.21 × 1.054 + 3.71 × 1.178 + 0.07 × 1.113) × $33.4009 = $155.97

Open 96416 in the RVU calculator

Payment rules and modifiers for 96416

The CMS indicators that decide how 96416 is paid alongside other services.

CMS payment indicators · 96416

Pump infusion, prolonged infusion over eight hours

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures0No multiple-procedure reduction.
Bilateral (modifier 50)0The 150% bilateral adjustment doesn’t apply.
Assistant at surgery (80/81/82/AS)0Not paid without supporting documentation.
Co-surgeons (62)0Not permitted.
Team surgery (66)0Not permitted.
Professional/technical5Incident-to service.

Codes related to 96416

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

Codes related to 96416
CodeHow it relatesOffice range, Washington, DC area
Used instead
96413Chemo IV infusion, initial drug, first hourUsed for a shorter intravenous chemotherapy infusion rather than prolonged pump initiation.$155.68
96425Chemotherapy infusion, prolonged intra-arterial pumpDescribes prolonged pump-based chemotherapy infusion by the intra-arterial route.$204.05
96409Chemotherapy push, single or initial drugUsed for chemotherapy delivered by intravenous push rather than prolonged pump infusion.$122.03
Same family
96415Chemo infusion add-on, each additional hourReports an additional hour for qualifying intravenous chemotherapy infusion services.$32.61
Often billed with
96417Chemotherapy infusion, additional sequential drugMay describe a distinct sequential chemotherapy infusion of another drug during the encounter.$77.36

How 96416 has changed in Washington, DC area

96416 · Office / nonfacility

$155.97

Effective 2026-10-01

The base rate is $16.96 higher than on 2025-10-01, moving from $139.01 to $155.97 (12.2%).

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

    $139.01changed to$155.97

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 3.37 changed to 3.71
    • Malpractice RVU 0.05 changed to 0.07
    • Work GPCI 1.057 changed to 1.054
    • Practice expense GPCI 1.192 changed to 1.178
    • Malpractice GPCI 1.168 changed to 1.113

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $150.57changed to$139.01

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.54 changed to 3.37
    • Malpractice RVU 0.07 changed to 0.05

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $148.12changed to$150.57

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $156.48changed to$148.12

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.55 changed to 3.54
    • Work GPCI 1.056 changed to 1.057
    • Practice expense GPCI 1.214 changed to 1.192
    • Malpractice GPCI 1.231 changed to 1.168

  5. January 1, 2023

    RVU23A

    $168.65changed to$156.48

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.68 changed to 3.55
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.054 changed to 1.056
    • Practice expense GPCI 1.236 changed to 1.214
    • Malpractice GPCI 1.294 changed to 1.231

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $180.85changed to$168.65

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 3.92 changed to 3.68
    • Malpractice RVU 0.09 changed to 0.08

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $172.94changed to$180.85

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.65 changed to 3.92
    • Work GPCI 1.049 changed to 1.054
    • Practice expense GPCI 1.221 changed to 1.236
    • Malpractice GPCI 1.277 changed to 1.294

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $171.77changed to$172.94

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.70 changed to 3.65
    • Malpractice RVU 0.07 changed to 0.09
    • Work GPCI 1.045 changed to 1.049
    • Practice expense GPCI 1.205 changed to 1.221
    • Malpractice GPCI 1.261 changed to 1.277

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $176.37changed to$171.77

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.80 changed to 3.70
    • Malpractice RVU 0.08 changed to 0.07

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $168.94changed to$176.37

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.65 changed to 3.80
    • Malpractice RVU 0.07 changed to 0.08
    • Work GPCI 1.048 changed to 1.045
    • Malpractice GPCI 1.271 changed to 1.261

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $169.91changed to$168.94

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.67 changed to 3.65
    • Malpractice RVU 0.08 changed to 0.07
    • Work GPCI 1.051 changed to 1.048
    • Malpractice GPCI 1.280 changed to 1.271

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $169.63changed to$169.91

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.66 changed to 3.67
    • Malpractice RVU 0.07 changed to 0.08

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $168.78changed to$169.63

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $165.93changed to$168.78

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.60 changed to 3.66
    • Work GPCI 1.050 changed to 1.051
    • Practice expense GPCI 1.202 changed to 1.205
    • Malpractice GPCI 1.205 changed to 1.280

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $169.56changed to$165.93

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.91 changed to 3.60
    • Work GPCI 1.049 changed to 1.050
    • Practice expense GPCI 1.198 changed to 1.202
    • Malpractice GPCI 1.130 changed to 1.205

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $169.56

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$155.97Not available in this settingRVU26D
2026-07-01$155.97Not available in this settingRVU26C
2026-04-01$155.97Not available in this settingRVU26B
2026-01-01$155.97Not available in this settingRVU26A
2025-10-01$139.01Not available in this settingRVU25D
2025-07-01$139.01Not available in this settingRVU25C
2025-04-01$139.01Not available in this settingRVU25B
2025-01-01$139.01Not available in this settingRVU25A
2024-10-01$150.57Not available in this settingRVU24D
2024-07-01$150.57Not available in this settingRVU24C
2024-04-01$150.57Not available in this settingRVU24B
2024-03-09$150.57Not available in this settingRVU24AR
2024-01-01$148.12Not available in this settingRVU24A
2023-10-01$156.48Not available in this settingRVU23D
2023-07-01$156.48Not available in this settingRVU23C
2023-04-01$156.48Not available in this settingRVU23B
2023-01-01$156.48Not available in this settingRVU23A
2022-10-01$168.65Not available in this settingRVU22D
2022-07-01$168.65Not available in this settingRVU22C
2022-04-01$168.65Not available in this settingRVU22B
2022-01-01$168.65Not available in this settingRVU22A
2021-10-01$180.85Not available in this settingRVU21D
2021-07-01$180.85Not available in this settingRVU21C
2021-04-01$180.85Not available in this settingRVU21B
2021-01-01$180.85Not available in this settingRVU21A
2020-10-01$172.94Not available in this settingRVU20D
2020-07-01$172.94Not available in this settingRVU20C
2020-04-01$172.94Not available in this settingRVU20B
2020-01-01$172.94Not available in this settingRVU20A
2019-10-01$171.77Not available in this settingRVU19D
2019-07-01$171.77Not available in this settingRVU19C
2019-04-01$171.77Not available in this settingRVU19B
2019-01-01$171.77Not available in this settingRVU19A
2018-10-01$176.37Not available in this settingRVU18D
2018-07-01$176.37Not available in this settingRVU18C
2018-04-01$176.37Not available in this settingRVU18B
2018-01-01$176.37Not available in this settingRVU18AR1
2017-10-01$168.94Not available in this settingRVU17D
2017-07-01$168.94Not available in this settingRVU17C
2017-04-01$168.94Not available in this settingRVU17B
2017-01-01$168.94Not available in this settingRVU17A
2016-10-01$169.91Not available in this settingRVU16D
2016-07-01$169.91Not available in this settingRVU16C
2016-04-01$169.91Not available in this settingRVU16B
2016-01-01$169.91Not available in this settingRVU16A
2015-10-01$169.63Not available in this settingRVU15D
2015-07-01$169.63Not available in this settingRVU15C
2015-04-01$168.78Not available in this settingRVU15B
2015-01-01$168.78Not available in this settingRVU15A
2014-10-01$165.93Not available in this settingRVU14D
2014-07-01$165.93Not available in this settingRVU14C
2014-04-01$165.93Not available in this settingRVU14B
2014-01-01$165.93Not available in this settingRVU14A
2013-10-01$169.56Not available in this settingRVU13D
2013-07-01$169.56Not available in this settingRVU13C
2013-04-01$169.56Not available in this settingRVU13B
2013-01-01$169.56Not available in this settingRVU13AR

Price 96416 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

  • Washington

Browse all communities in District of Columbia

96416 billing questions

When should 96416 be used instead of 96413?

Use 96416 when intravenous chemotherapy is initiated for an infusion lasting more than eight hours through a portable or implantable pump. Code 96413 describes a shorter intravenous infusion service.

Is 96416 reported for every hour of pump delivery?

No. It reports initiation of the prolonged pump infusion, not repeated hourly increments.

Is the chemotherapy drug included in 96416?

The code reports the administration service. Report the chemotherapy drug separately when applicable.

What documentation supports 96416?

Document the drug, intravenous route, use of a portable or implantable pump, infusion duration, and initiation of the infusion.

What supervision is required for Medicare billing?

CMS identifies 96416 as an incident-to service. It may be billed only when performed under physician supervision.

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 96416PPRRVU2026_Oct_nonQPP.csv, line 12,803 (RVU26D)
Geographic factors for Washington, DC areaGPCI2026.csv, line 39 (RVU26D)

Open CMS sourceHow we calculate rates

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