CPT code 96425: Chemotherapy infusion, prolonged intra-arterial pump2026 Medicare rate & RVUs

Medicare pays $174.02 for 96425 nationally in the office. Local office rates run $149.02–$245.72.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96425 covers

This service covers starting a prolonged chemotherapy infusion into an artery using a portable or implantable pump. It may be used for arterial drug delivery, including liver-directed treatment through an implanted hepatic artery infusion pump. Oncology physicians and supervised clinical staff may provide the service in an outpatient treatment setting when the treatment plan calls for this route and prolonged delivery method.

Select the code when the arterial infusion is initiated and the planned administration exceeds eight hours using the required pump method; an arterial push or shorter infusion has a different code. Document the drug, intra-arterial route, pump method, and infusion plan or duration. The code represents the administration service, rather than the chemotherapy drug itself. Under the CMS rule for this code, it is billed only when performed under physician supervision as an incident-to service.

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 96425 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96425 rates by state

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

How the 96425 rate is calculated

Each of 96425’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 96425

The CMS indicators that decide how 96425 is paid alongside other services.

96425 compared with similar codes

How to choose

96416Pump infusionProlonged infusion over eight hours

Both describe initiation of prolonged chemotherapy infusion using a pump, but 96416 is for intravenous delivery; 96425 is for intra-arterial delivery.

96422Arterial infusionUp to one hour

96422 describes intra-arterial infusion for up to one hour. Choose 96425 when initiating a pump infusion planned to last more than eight hours.

96423Chemotherapy infusionIntra-arterial, each additional hour

96423 accounts for an additional hour of intra-arterial infusion. 96425 describes initiation of the prolonged pump infusion, not added infusion time.

96420Chemotherapy pushIntra-arterial route

96420 is for intra-arterial chemotherapy given by push technique; 96425 is for prolonged intra-arterial infusion through a pump.

Codes related to 96425

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

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