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

Reports initiation of prolonged intra-arterial chemotherapy delivered for more than eight hours through a portable or implantable infusion pump.

CMS RVU26DEffective Oct 1, 2026One payment locality

In Connecticut, Medicare pays $187.58 for 96425 in the office.

$187.58Office (non-facility)
Not available in this settingHospital or facility
+7.8%vs the national office rate ($174.02)

Check a contract rate as a % of Medicare · 96425 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 96425 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in Connecticut
  2. What 96425 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 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.

How Connecticut compares for 96425

Across 109 of 109 payment localities, the office rate for 96425 runs from $149.02 in Arkansas to $245.72 in San Benito County, CA. Connecticut pays $187.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

96425 in Connecticut vs other payment areas
  1. Connecticut · this page$187.58
  2. Los Angeles, CA · California$203.15+$15.57
  3. Washington, DC area · District of Columbia$204.05+$16.47
  4. Miami, FL · Florida$186.39−$1.19
  5. Chicago, IL · Illinois$179.64−$7.94
  6. Manhattan, NY · New York$203.21+$15.63
  7. Alaska · Alaska$185.91−$1.67

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

Every other payment area

96425 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$151.84—
ArkansasArkansas$149.02—
ArizonaArizona$168.38—
Bakersfield, CACalifornia$188.50—
Chico, CACalifornia$188.22—
El Centro, CACalifornia$188.24—
Fresno, CACalifornia$188.22—
Hanford, CACalifornia$188.22—

96425 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.

$149.02

$216.97

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

View every state and territory as a table
96425 office rate range by state
State / territoryOffice rate rangeLocalities
AK$185.911
AL$151.841
AR$149.021
AZ$168.381
CA$188.22–$245.7229
CO$183.821
CT$187.581
DC$204.051
DE$171.701
FL$168.62–$186.393
GA$156.94–$177.412
GU$195.031
HI$195.031
IA$157.811
ID$158.911
IL$161.76–$181.344
IN$160.111
KS$156.391
KY$155.431
LA$154.93–$164.802
MA$182.09–$205.792
MD$175.75–$204.053
ME$159.46–$171.182
MI$160.17–$170.782
MN$176.211
MO$151.20–$166.123
MS$150.171
MT$174.011
NC$161.661
ND$171.841
NE$159.051
NH$180.311
NJ$189.75–$200.972
NM$161.091
NV$173.571
NY$164.69–$208.655
OH$159.721
OK$155.581
OR$172.27–$191.452
PA$160.31–$181.582
PR$175.771
RI$179.161
SC$160.951
SD$171.581
TN$157.331
TX$158.94–$183.168
UT$163.761
VA$170.14–$204.052
VI$175.771
VT$170.561
WA$181.94–$211.012
WI$164.561
WV$154.031
WY$173.061

See 96425 in every payment locality

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.

How the rate is built · 96425

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.17

0.17 RVUs× 1.000 GPCI

Practice expense4.93

4.93 RVUs× 1.000 GPCI

Malpractice0.11

0.11 RVUs× 1.000 GPCI

Adjusted RVUs

5.2100

Conversion factor

$33.4009

Medicare rate

$174.02

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

The exact Connecticut inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,808

Code
96425
Physician work
0.17
Practice expense
4.93
Malpractice
0.11

GPCI2026.csv

38

Locality
Connecticut
Physician work
1.020
Practice expense
1.077
Malpractice
1.210
Office calculation for 96425 in Connecticut
ComponentRVULocality factorAdjusted
Physician work0.17× 1.0200.1734
Practice expense4.93× 1.0775.3096
Malpractice0.11× 1.2100.1331
Total RVUs5.6161
Conversion factor× 33.4009

Office rate, Connecticut$187.58

Office: (0.17 × 1.02 + 4.93 × 1.077 + 0.11 × 1.21) × $33.4009 = $187.58

Open 96425 in the RVU calculator

Payment rules and modifiers for 96425

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

CMS payment indicators · 96425

Chemotherapy infusion, prolonged intra-arterial pump

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 96425

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

Codes related to 96425
CodeHow it relatesOffice range, Connecticut
Used instead
96416Pump infusion, prolonged infusion over eight hoursProlonged pump infusion by the intravenous route rather than the intra-arterial route.$143.44
Same family
96420Chemotherapy push, intra-arterial routeIntra-arterial chemotherapy administration by push rather than prolonged pump infusion.$113.26
96422Arterial infusion, up to one hourIntra-arterial infusion for a shorter duration, rather than prolonged pump delivery.$151.07
96423Chemotherapy infusion, intra-arterial, each additional hourAdditional-hour code for intra-arterial infusion, distinct from initiating prolonged pump infusion.$81.20

How 96425 has changed in Connecticut

96425 · Office / nonfacility

$187.58

Effective 2026-10-01

The base rate is $18.19 higher than on 2025-10-01, moving from $169.39 to $187.58 (10.7%).

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

    $169.39changed to$187.58

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 4.53 changed to 4.93
    • Malpractice RVU 0.10 changed to 0.11
    • Work GPCI 1.022 changed to 1.020
    • Practice expense GPCI 1.091 changed to 1.077
    • Malpractice GPCI 1.207 changed to 1.210

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $183.43changed to$169.39

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 4.77 changed to 4.53
    • Malpractice RVU 0.11 changed to 0.10

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $180.44changed to$183.43

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $188.43changed to$180.44

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 4.78 changed to 4.77
    • Work GPCI 1.030 changed to 1.022
    • Practice expense GPCI 1.102 changed to 1.091
    • Malpractice GPCI 1.070 changed to 1.207

  5. January 1, 2023

    RVU23A

    $200.87changed to$188.43

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 4.96 changed to 4.78
    • Work GPCI 1.037 changed to 1.030
    • Practice expense GPCI 1.114 changed to 1.102
    • Malpractice GPCI 0.934 changed to 1.070

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $213.68changed to$200.87

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 5.23 changed to 4.96
    • Malpractice RVU 0.13 changed to 0.11

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $204.26changed to$213.68

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 4.82 changed to 5.23
    • Malpractice RVU 0.11 changed to 0.13
    • Work GPCI 1.029 changed to 1.037
    • Practice expense GPCI 1.113 changed to 1.114
    • Malpractice GPCI 1.094 changed to 0.934

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $206.05changed to$204.26

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 4.85 changed to 4.82
    • Malpractice RVU 0.12 changed to 0.11
    • Work GPCI 1.021 changed to 1.029
    • Practice expense GPCI 1.112 changed to 1.113
    • Malpractice GPCI 1.255 changed to 1.094

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $219.54changed to$206.05

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 5.17 changed to 4.85
    • Malpractice RVU 0.14 changed to 0.12

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $207.23changed to$219.54

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 4.88 changed to 5.17
    • Malpractice RVU 0.12 changed to 0.14
    • Work GPCI 1.023 changed to 1.021
    • Practice expense GPCI 1.117 changed to 1.112
    • Malpractice GPCI 1.244 changed to 1.255

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $204.98changed to$207.23

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 4.82 changed to 4.88
    • Work GPCI 1.024 changed to 1.023
    • Practice expense GPCI 1.121 changed to 1.117
    • Malpractice GPCI 1.232 changed to 1.244

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $204.11changed to$204.98

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 4.78 changed to 4.82

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $203.10changed to$204.11

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $201.35changed to$203.10

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 4.77 changed to 4.78
    • Malpractice RVU 0.10 changed to 0.12
    • Practice expense GPCI 1.116 changed to 1.121
    • Malpractice GPCI 1.234 changed to 1.232

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $205.75changed to$201.35

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 5.18 changed to 4.77
    • Practice expense GPCI 1.110 changed to 1.116
    • Malpractice GPCI 1.235 changed to 1.234

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $205.75

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$187.58Not available in this settingRVU26D
2026-07-01$187.58Not available in this settingRVU26C
2026-04-01$187.58Not available in this settingRVU26B
2026-01-01$187.58Not available in this settingRVU26A
2025-10-01$169.39Not available in this settingRVU25D
2025-07-01$169.39Not available in this settingRVU25C
2025-04-01$169.39Not available in this settingRVU25B
2025-01-01$169.39Not available in this settingRVU25A
2024-10-01$183.43Not available in this settingRVU24D
2024-07-01$183.43Not available in this settingRVU24C
2024-04-01$183.43Not available in this settingRVU24B
2024-03-09$183.43Not available in this settingRVU24AR
2024-01-01$180.44Not available in this settingRVU24A
2023-10-01$188.43Not available in this settingRVU23D
2023-07-01$188.43Not available in this settingRVU23C
2023-04-01$188.43Not available in this settingRVU23B
2023-01-01$188.43Not available in this settingRVU23A
2022-10-01$200.87Not available in this settingRVU22D
2022-07-01$200.87Not available in this settingRVU22C
2022-04-01$200.87Not available in this settingRVU22B
2022-01-01$200.87Not available in this settingRVU22A
2021-10-01$213.68Not available in this settingRVU21D
2021-07-01$213.68Not available in this settingRVU21C
2021-04-01$213.68Not available in this settingRVU21B
2021-01-01$213.68Not available in this settingRVU21A
2020-10-01$204.26Not available in this settingRVU20D
2020-07-01$204.26Not available in this settingRVU20C
2020-04-01$204.26Not available in this settingRVU20B
2020-01-01$204.26Not available in this settingRVU20A
2019-10-01$206.05Not available in this settingRVU19D
2019-07-01$206.05Not available in this settingRVU19C
2019-04-01$206.05Not available in this settingRVU19B
2019-01-01$206.05Not available in this settingRVU19A
2018-10-01$219.54Not available in this settingRVU18D
2018-07-01$219.54Not available in this settingRVU18C
2018-04-01$219.54Not available in this settingRVU18B
2018-01-01$219.54Not available in this settingRVU18AR1
2017-10-01$207.23Not available in this settingRVU17D
2017-07-01$207.23Not available in this settingRVU17C
2017-04-01$207.23Not available in this settingRVU17B
2017-01-01$207.23Not available in this settingRVU17A
2016-10-01$204.98Not available in this settingRVU16D
2016-07-01$204.98Not available in this settingRVU16C
2016-04-01$204.98Not available in this settingRVU16B
2016-01-01$204.98Not available in this settingRVU16A
2015-10-01$204.11Not available in this settingRVU15D
2015-07-01$204.11Not available in this settingRVU15C
2015-04-01$203.10Not available in this settingRVU15B
2015-01-01$203.10Not available in this settingRVU15A
2014-10-01$201.35Not available in this settingRVU14D
2014-07-01$201.35Not available in this settingRVU14C
2014-04-01$201.35Not available in this settingRVU14B
2014-01-01$201.35Not available in this settingRVU14A
2013-10-01$205.75Not available in this settingRVU13D
2013-07-01$205.75Not available in this settingRVU13C
2013-04-01$205.75Not available in this settingRVU13B
2013-01-01$205.75Not available in this settingRVU13AR

Price 96425 for an earlier date of service

Where the Connecticut rate applies

Connecticut is a Medicare payment area, not a city. Our Census mapping connects it to 215 cities and communities in Connecticut. Some span more than one payment area; confirm with the service ZIP.

  • Ansonia
  • Ball Pond
  • Baltic
  • Bantam
  • Bethel
  • Bethlehem Village
  • Bigelow Corners
  • Blue Hills

Browse all communities in Connecticut

96425 billing questions

When should 96425 be selected instead of an arterial infusion code?

Use 96425 for initiation of a prolonged intra-arterial infusion lasting more than eight hours that requires a portable or implantable pump. Shorter arterial infusions and arterial push administration are reported under different codes.

Does 96425 include the chemotherapy drug?

No. The code represents the administration service; the drug product is reported separately when applicable.

What documentation supports reporting 96425?

Document the intra-arterial route, chemotherapy drug, pump method, and the prolonged infusion plan or duration. The record should support that the infusion was initiated and performed under physician supervision.

Is this code reported for each hour of infusion?

No. 96425 describes initiation of the prolonged pump infusion, not an additional unit for each hour.

Can clinical staff perform the service?

Yes, when performed under physician supervision as an incident-to service, consistent with the CMS rule for this code.

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 96425PPRRVU2026_Oct_nonQPP.csv, line 12,808 (RVU26D)
Geographic factors for ConnecticutGPCI2026.csv, line 38 (RVU26D)

Open CMS sourceHow we calculate rates

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