CPT code 96425: Chemotherapy infusion, prolonged intra-arterial pump2026 Medicare rate & RVUs in Missouri
Reports initiation of prolonged intra-arterial chemotherapy delivered for more than eight hours through a portable or implantable infusion pump.
Medicare pays $151.20–$166.12 for 96425 in the office in Missouri, from Rest of Missouri to Metropolitan St. Louis, MO. 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 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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$151.20 to $166.12
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | $163.89 | Unavailable |
| Metropolitan St. Louis, MO | $166.12 | Unavailable |
| Rest of Missouri | $151.20 | Unavailable |
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
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.
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
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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. |
96425 compared with similar codes
Compare codes · National
5 codes, side by side
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.
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
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