CPT code 96423: Chemotherapy infusion, intra-arterial, each additional hour2026 Medicare rate & RVUs in California
Reports each additional qualifying hour of chemotherapy delivered by intra-arterial infusion after the initial infusion period represented by the primary service.
Medicare pays $81.35–$105.45 for 96423 in the office in California, from Chico, CA to San Benito County, CA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 96423 covers
This add-on service covers continued delivery of a chemotherapy agent through an artery after the initial intra-arterial infusion period. It is used in oncology care when treatment is administered through an arterial catheter rather than by intravenous infusion, injection, or a prolonged pump. Oncology clinicians and qualified staff may perform the administration in an outpatient or hospital setting, with the service furnished under physician supervision as an incident-to service.
Report 96423 with the primary intra-arterial infusion service, 96422; it is not a stand-alone administration code. Assign units from documented infusion duration and follow the applicable CPT time instructions. The record should identify the drug, route, infusion start and stop times, and the total time supporting the additional-hour unit or units. CMS classifies this as an add-on code paid within the primary procedure's global period, and permits billing 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.
Where 96423 pays more and less in California
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
29 payment localities
$81.35 to $105.45
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield, CA | $81.48 | Unavailable |
| Chico, CA | $81.35 | Unavailable |
| El Centro, CA | $81.36 | Unavailable |
| Fresno, CA | $81.35 | Unavailable |
| Hanford, CA | $81.35 | Unavailable |
| Los Angeles, CA | $87.63 | Unavailable |
| Madera, CA | $81.35 | Unavailable |
| Marin County, CA | $103.06 | Unavailable |
| Merced, CA | $81.35 | Unavailable |
| Modesto, CA | $81.35 | Unavailable |
| Napa, CA | $96.69 | Unavailable |
| Oxnard, CA | $87.42 | Unavailable |
| Redding, CA | $81.35 | Unavailable |
| Rest of California | $81.35 | Unavailable |
| Riverside, CA | $81.88 | Unavailable |
| Sacramento, CA | $86.02 | Unavailable |
| Salinas, CA | $85.72 | Unavailable |
| San Benito County, CA | $105.45 | Unavailable |
| San Diego, CA | $88.25 | Unavailable |
| San Francisco, CA | $103.00 | Unavailable |
| San Luis Obispo, CA | $84.28 | Unavailable |
| Santa Clara County, CA | $105.22 | Unavailable |
| Santa Cruz, CA | $89.48 | Unavailable |
| Santa Maria, CA | $86.18 | Unavailable |
| Santa Rosa, CA | $90.42 | Unavailable |
| Stockton, CA | $81.35 | Unavailable |
| Vallejo, CA | $96.61 | Unavailable |
| Visalia, CA | $81.35 | Unavailable |
| Yuba City, CA | $81.35 | Unavailable |
How the 96423 rate is calculated
Each of 96423’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 · 96423
RVUs × geographic indexes × conversion factor
Work0.17
0.17 RVUs× 1.000 GPCI
Practice expense2.04
2.04 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.2600
Conversion factor
$33.4009
Medicare rate
$75.49
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96423
The CMS indicators that decide how 96423 is paid alongside other services.
CMS payment indicators · 96423
Chemotherapy infusion, intra-arterial, each additional hour
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
96423 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96422Arterial infusionUp to one hour
- 96422 represents the primary intra-arterial infusion service for the initial period; 96423 is reported only for supported additional infusion time.
- 96415Chemo infusion add-onEach additional hour
- Both represent additional chemotherapy infusion time, but 96415 is for intravenous administration and 96423 is for intra-arterial administration.
- 96420Chemotherapy pushIntra-arterial route
- 96420 describes intra-arterial chemotherapy delivered by push technique; 96423 is for additional time in an infusion.
- 96417Chemotherapy infusionAdditional sequential drug
- 96417 concerns an additional sequential chemotherapy infusion, while 96423 accounts for additional time in the intra-arterial infusion service.
96423 billing questions
When should 96423 be reported instead of 96415?
Use 96423 for additional qualifying time during an intra-arterial chemotherapy infusion. Code 96415 describes additional time for an intravenous chemotherapy infusion.
Can 96423 be billed by itself?
No. It is an add-on code reported with the primary intra-arterial infusion service, 96422.
What documentation supports the additional-hour units?
Document the chemotherapy agent, intra-arterial route, and infusion start and stop times. The recorded duration must support the units under the applicable CPT time instructions.
Does physician supervision affect reporting?
Yes. CMS identifies this as an incident-to service and allows billing only when it is performed under physician supervision.
Is 96423 used for an intra-arterial push?
No. It describes additional infusion time, not push administration. Code 96420 is the related intra-arterial push service.
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
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