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CPT code 96416: Pump infusion, prolonged infusion over eight hours2026 Medicare rate & RVUs in New Mexico

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 New Mexico, Medicare pays $123.45 for 96416 in the office.

$123.45Office (non-facility)
Not available in this settingHospital or facility
−7.4%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 New Mexico
  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 New Mexico 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. New Mexico pays $123.45. The RVUs are the same everywhere; the geographic indexes change the dollars.

96416 in New Mexico vs other payment areas
  1. New Mexico · this page$123.45
  2. Los Angeles, CA · California$155.45+$32.00
  3. Washington, DC area · District of Columbia$155.97+$32.52
  4. Miami, FL · Florida$141.93+$18.48
  5. Chicago, IL · Illinois$136.97+$13.52
  6. Manhattan, NY · New York$155.16+$31.71
  7. Alaska · Alaska$143.78+$20.33

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

Every other payment area

96416 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$116.77—
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—

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 New Mexico 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

77

Locality
New Mexico
Physician work
1.000
Practice expense
0.917
Malpractice
1.201
Office calculation for 96416 in New Mexico
ComponentRVULocality factorAdjusted
Physician work0.21× 1.0000.2100
Practice expense3.71× 0.9173.4021
Malpractice0.07× 1.2010.0841
Total RVUs3.6961
Conversion factor× 33.4009

Office rate, New Mexico$123.45

Office: (0.21 × 1 + 3.71 × 0.917 + 0.07 × 1.201) × $33.4009 = $123.45

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, New Mexico
Used instead
96413Chemo IV infusion, initial drug, first hourUsed for a shorter intravenous chemotherapy infusion rather than prolonged pump initiation.$123.65
96425Chemotherapy infusion, prolonged intra-arterial pumpDescribes prolonged pump-based chemotherapy infusion by the intra-arterial route.$161.09
96409Chemotherapy push, single or initial drugUsed for chemotherapy delivered by intravenous push rather than prolonged pump infusion.$97.10
Same family
96415Chemo infusion add-on, each additional hourReports an additional hour for qualifying intravenous chemotherapy infusion services.$26.75
Often billed with
96417Chemotherapy infusion, additional sequential drugMay describe a distinct sequential chemotherapy infusion of another drug during the encounter.$61.82

How 96416 has changed in New Mexico

96416 · Office / nonfacility

$123.45

Effective 2026-10-01

The base rate is $15.78 higher than on 2025-10-01, moving from $107.67 to $123.45 (14.7%).

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

    $107.67changed to$123.45

    • 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
    • Practice expense GPCI 0.908 changed to 0.917
    • Malpractice GPCI 1.172 changed to 1.201

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $116.72changed to$107.67

    • 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

    $114.81changed to$116.72

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $118.40changed to$114.81

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.55 changed to 3.54
    • Practice expense GPCI 0.902 changed to 0.908
    • Malpractice GPCI 1.169 changed to 1.172

  5. January 1, 2023

    RVU23A

    $124.60changed to$118.40

    • 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
    • Practice expense GPCI 0.896 changed to 0.902
    • Malpractice GPCI 1.166 changed to 1.169

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $133.54changed to$124.60

    • 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

    $131.11changed to$133.54

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.65 changed to 3.92
    • Practice expense GPCI 0.908 changed to 0.896
    • Malpractice GPCI 1.207 changed to 1.166

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $133.52changed to$131.11

    • 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
    • Practice expense GPCI 0.921 changed to 0.908
    • Malpractice GPCI 1.247 changed to 1.207

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $137.14changed to$133.52

    • 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

    $131.08changed to$137.14

    • 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
    • Practice expense GPCI 0.920 changed to 0.921
    • Malpractice GPCI 1.204 changed to 1.247

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $131.60changed to$131.08

    • 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
    • Practice expense GPCI 0.919 changed to 0.920
    • Malpractice GPCI 1.161 changed to 1.204

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $131.33changed to$131.60

    • 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

    $130.68changed to$131.33

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $128.62changed to$130.68

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.60 changed to 3.66
    • Practice expense GPCI 0.918 changed to 0.919
    • Malpractice GPCI 1.079 changed to 1.161

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $131.37changed to$128.62

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.91 changed to 3.60
    • Practice expense GPCI 0.916 changed to 0.918
    • Malpractice GPCI 0.997 changed to 1.079

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $131.37

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$123.45Not available in this settingRVU26D
2026-07-01$123.45Not available in this settingRVU26C
2026-04-01$123.45Not available in this settingRVU26B
2026-01-01$123.45Not available in this settingRVU26A
2025-10-01$107.67Not available in this settingRVU25D
2025-07-01$107.67Not available in this settingRVU25C
2025-04-01$107.67Not available in this settingRVU25B
2025-01-01$107.67Not available in this settingRVU25A
2024-10-01$116.72Not available in this settingRVU24D
2024-07-01$116.72Not available in this settingRVU24C
2024-04-01$116.72Not available in this settingRVU24B
2024-03-09$116.72Not available in this settingRVU24AR
2024-01-01$114.81Not available in this settingRVU24A
2023-10-01$118.40Not available in this settingRVU23D
2023-07-01$118.40Not available in this settingRVU23C
2023-04-01$118.40Not available in this settingRVU23B
2023-01-01$118.40Not available in this settingRVU23A
2022-10-01$124.60Not available in this settingRVU22D
2022-07-01$124.60Not available in this settingRVU22C
2022-04-01$124.60Not available in this settingRVU22B
2022-01-01$124.60Not available in this settingRVU22A
2021-10-01$133.54Not available in this settingRVU21D
2021-07-01$133.54Not available in this settingRVU21C
2021-04-01$133.54Not available in this settingRVU21B
2021-01-01$133.54Not available in this settingRVU21A
2020-10-01$131.11Not available in this settingRVU20D
2020-07-01$131.11Not available in this settingRVU20C
2020-04-01$131.11Not available in this settingRVU20B
2020-01-01$131.11Not available in this settingRVU20A
2019-10-01$133.52Not available in this settingRVU19D
2019-07-01$133.52Not available in this settingRVU19C
2019-04-01$133.52Not available in this settingRVU19B
2019-01-01$133.52Not available in this settingRVU19A
2018-10-01$137.14Not available in this settingRVU18D
2018-07-01$137.14Not available in this settingRVU18C
2018-04-01$137.14Not available in this settingRVU18B
2018-01-01$137.14Not available in this settingRVU18AR1
2017-10-01$131.08Not available in this settingRVU17D
2017-07-01$131.08Not available in this settingRVU17C
2017-04-01$131.08Not available in this settingRVU17B
2017-01-01$131.08Not available in this settingRVU17A
2016-10-01$131.60Not available in this settingRVU16D
2016-07-01$131.60Not available in this settingRVU16C
2016-04-01$131.60Not available in this settingRVU16B
2016-01-01$131.60Not available in this settingRVU16A
2015-10-01$131.33Not available in this settingRVU15D
2015-07-01$131.33Not available in this settingRVU15C
2015-04-01$130.68Not available in this settingRVU15B
2015-01-01$130.68Not available in this settingRVU15A
2014-10-01$128.62Not available in this settingRVU14D
2014-07-01$128.62Not available in this settingRVU14C
2014-04-01$128.62Not available in this settingRVU14B
2014-01-01$128.62Not available in this settingRVU14A
2013-10-01$131.37Not available in this settingRVU13D
2013-07-01$131.37Not available in this settingRVU13C
2013-04-01$131.37Not available in this settingRVU13B
2013-01-01$131.37Not available in this settingRVU13AR

Price 96416 for an earlier date of service

Where the New Mexico rate applies

New Mexico is a Medicare payment area, not a city. Our Census mapping connects it to 528 cities and communities in New Mexico. Some span more than one payment area; confirm with the service ZIP.

  • Abeytas
  • Abiquiu
  • Acomita Lake
  • Adelino
  • Agua Fria
  • Alamillo
  • Alamo
  • Alamogordo

Browse all communities in New Mexico

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 New MexicoGPCI2026.csv, line 77 (RVU26D)

Open CMS sourceHow we calculate rates

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