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CPT code 96521: Pump refill, portable infusion pump2026 Medicare rate & RVUs in North Carolina

Reports refilling and maintaining a portable infusion pump used to deliver medication over time, when the pump service is performed under physician supervision.

CMS RVU26DEffective Oct 1, 2026One payment locality58.1K Medicare services in 2024

In North Carolina, Medicare pays $133.78 for 96521 in the office.

$133.78Office (non-facility)
Not available in this settingHospital or facility
−6.9%vs the national office rate ($143.62)

Check a contract rate as a % of Medicare · 96521 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 96521 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 96521 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 96521 covers

This service covers refilling and maintaining a portable infusion pump that delivers medication over time. It is commonly performed in an office or outpatient setting during ongoing treatment, including ambulatory infusion regimens. The work centers on the portable pump and its continued operation, rather than an injection or care of an implanted pump.

Report 96521 for the portable-pump refill and maintenance service, and document the device, work performed, and treatment context. Use 96522 when the service involves an implanted pump or reservoir; 96523 describes irrigation of a drug-delivery device. CMS classifies 96521 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 North Carolina compares for 96521

Across 109 of 109 payment localities, the office rate for 96521 runs from $123.56 in Arkansas to $202.66 in San Benito County, CA. North Carolina pays $133.78. The RVUs are the same everywhere; the geographic indexes change the dollars.

96521 in North Carolina vs other payment areas
  1. North Carolina · this page$133.78
  2. Los Angeles, CA · California$167.70+$33.92
  3. Washington, DC area · District of Columbia$168.17+$34.39
  4. Miami, FL · Florida$152.70+$18.92
  5. Chicago, IL · Illinois$147.37+$13.59
  6. Manhattan, NY · New York$167.19+$33.41
  7. Alaska · Alaska$154.81+$21.03

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

Every other payment area

96521 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$125.83—
ArkansasArkansas$123.56—
ArizonaArizona$139.12—
Bakersfield, CACalifornia$155.73—
Chico, CACalifornia$155.55—
El Centro, CACalifornia$155.56—
Fresno, CACalifornia$155.55—
Hanford, CACalifornia$155.55—

96521 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.

$123.56

$179.11

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

View every state and territory as a table
96521 office rate range by state
State / territoryOffice rate rangeLocalities
AK$154.811
AL$125.831
AR$123.561
AZ$139.121
CA$155.55–$202.6629
CO$151.791
CT$154.591
DC$168.171
DE$141.811
FL$138.89–$152.703
GA$129.57–$146.262
GU$161.031
HI$161.031
IA$130.801
ID$131.651
IL$133.26–$149.104
IN$132.621
KS$129.571
KY$128.521
LA$128.08–$136.022
MA$150.38–$169.702
MD$145.11–$168.173
ME$132.00–$141.552
MI$132.24–$140.532
MN$145.871
MO$125.03–$137.183
MS$124.351
MT$143.621
NC$133.781
ND$142.241
NE$131.831
NH$148.841
NJ$156.48–$165.712
NM$132.951
NV$143.371
NY$136.22–$171.455
OH$131.961
OK$128.741
OR$142.39–$158.042
PA$132.49–$149.712
PR$145.071
RI$147.941
SC$133.071
SD$142.071
TN$130.321
TX$131.37–$151.168
UT$135.331
VA$140.65–$168.172
VI$145.071
VT$141.131
WA$150.27–$174.032
WI$136.371
WV$127.041
WY$143.021

See 96521 in every payment locality

How the 96521 rate is calculated

Each of 96521’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 · 96521

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.21

0.21 RVUs× 1.000 GPCI

Practice expense4.02

4.02 RVUs× 1.000 GPCI

Malpractice0.07

0.07 RVUs× 1.000 GPCI

Adjusted RVUs

4.3000

Conversion factor

$33.4009

Medicare rate

$143.62

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

12,812

Code
96521
Physician work
0.21
Practice expense
4.02
Malpractice
0.07

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 96521 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.21× 1.0000.2100
Practice expense4.02× 0.9333.7507
Malpractice0.07× 0.6390.0447
Total RVUs4.0054
Conversion factor× 33.4009

Office rate, North Carolina$133.78

Office: (0.21 × 1 + 4.02 × 0.933 + 0.07 × 0.639) × $33.4009 = $133.78

Open 96521 in the RVU calculator

Payment rules and modifiers for 96521

The CMS indicators that decide how 96521 is paid alongside other services.

CMS payment indicators · 96521

Pump refill, portable infusion 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 96521

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

Codes related to 96521
CodeHow it relatesOffice range, North Carolina
Same family
96522Pump refill, implantable systemic deliveryRefill and maintenance of an implanted pump or drug-delivery reservoir.$116.64
Used instead
96523Port irrigation, implanted drug-delivery access deviceUsed for irrigation of a drug-delivery device rather than portable-pump refill and maintenance.$24.30
Often billed with
96416Pump infusion, prolonged infusion over eight hoursMay be reported for separately performed initiation of a prolonged chemotherapy infusion using a pump.$124.12

How 96521 has changed in North Carolina

96521 · Office / nonfacility

$133.78

Effective 2026-10-01

The base rate is $28.05 higher than on 2025-10-01, moving from $105.73 to $133.78 (26.5%).

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

    $105.73changed to$133.78

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 3.26 changed to 4.02
    • Malpractice RVU 0.06 changed to 0.07
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $114.58changed to$105.73

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 3.44 changed to 3.26
    • Malpractice RVU 0.07 changed to 0.06

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $112.71changed to$114.58

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $118.51changed to$112.71

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 3.49 changed to 3.44
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $132.17changed to$118.51

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 3.81 changed to 3.49
    • Malpractice RVU 0.09 changed to 0.07
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $142.01changed to$132.17

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 4.08 changed to 3.81

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $138.59changed to$142.01

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 3.83 changed to 4.08
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $138.41changed to$138.59

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 3.84 changed to 3.83
    • Malpractice RVU 0.08 changed to 0.09
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $139.60changed to$138.41

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 3.88 changed to 3.84

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $132.00changed to$139.60

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 3.67 changed to 3.88
    • Malpractice RVU 0.07 changed to 0.08
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $129.65changed to$132.00

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 3.61 changed to 3.67
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $129.78changed to$129.65

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 3.60 changed to 3.61

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $129.14changed to$129.78

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $125.64changed to$129.14

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 3.51 changed to 3.60
    • Malpractice RVU 0.05 changed to 0.07
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $130.70changed to$125.64

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 3.88 changed to 3.51
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $130.70

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$133.78Not available in this settingRVU26D
2026-07-01$133.78Not available in this settingRVU26C
2026-04-01$133.78Not available in this settingRVU26B
2026-01-01$133.78Not available in this settingRVU26A
2025-10-01$105.73Not available in this settingRVU25D
2025-07-01$105.73Not available in this settingRVU25C
2025-04-01$105.73Not available in this settingRVU25B
2025-01-01$105.73Not available in this settingRVU25A
2024-10-01$114.58Not available in this settingRVU24D
2024-07-01$114.58Not available in this settingRVU24C
2024-04-01$114.58Not available in this settingRVU24B
2024-03-09$114.58Not available in this settingRVU24AR
2024-01-01$112.71Not available in this settingRVU24A
2023-10-01$118.51Not available in this settingRVU23D
2023-07-01$118.51Not available in this settingRVU23C
2023-04-01$118.51Not available in this settingRVU23B
2023-01-01$118.51Not available in this settingRVU23A
2022-10-01$132.17Not available in this settingRVU22D
2022-07-01$132.17Not available in this settingRVU22C
2022-04-01$132.17Not available in this settingRVU22B
2022-01-01$132.17Not available in this settingRVU22A
2021-10-01$142.01Not available in this settingRVU21D
2021-07-01$142.01Not available in this settingRVU21C
2021-04-01$142.01Not available in this settingRVU21B
2021-01-01$142.01Not available in this settingRVU21A
2020-10-01$138.59Not available in this settingRVU20D
2020-07-01$138.59Not available in this settingRVU20C
2020-04-01$138.59Not available in this settingRVU20B
2020-01-01$138.59Not available in this settingRVU20A
2019-10-01$138.41Not available in this settingRVU19D
2019-07-01$138.41Not available in this settingRVU19C
2019-04-01$138.41Not available in this settingRVU19B
2019-01-01$138.41Not available in this settingRVU19A
2018-10-01$139.60Not available in this settingRVU18D
2018-07-01$139.60Not available in this settingRVU18C
2018-04-01$139.60Not available in this settingRVU18B
2018-01-01$139.60Not available in this settingRVU18AR1
2017-10-01$132.00Not available in this settingRVU17D
2017-07-01$132.00Not available in this settingRVU17C
2017-04-01$132.00Not available in this settingRVU17B
2017-01-01$132.00Not available in this settingRVU17A
2016-10-01$129.65Not available in this settingRVU16D
2016-07-01$129.65Not available in this settingRVU16C
2016-04-01$129.65Not available in this settingRVU16B
2016-01-01$129.65Not available in this settingRVU16A
2015-10-01$129.78Not available in this settingRVU15D
2015-07-01$129.78Not available in this settingRVU15C
2015-04-01$129.14Not available in this settingRVU15B
2015-01-01$129.14Not available in this settingRVU15A
2014-10-01$125.64Not available in this settingRVU14D
2014-07-01$125.64Not available in this settingRVU14C
2014-04-01$125.64Not available in this settingRVU14B
2014-01-01$125.64Not available in this settingRVU14A
2013-10-01$130.70Not available in this settingRVU13D
2013-07-01$130.70Not available in this settingRVU13C
2013-04-01$130.70Not available in this settingRVU13B
2013-01-01$130.70Not available in this settingRVU13AR

Price 96521 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

96521 billing questions

How is 96521 different from 96522?

96521 is for refill and maintenance of a portable pump. Use 96522 for an implanted pump or drug-delivery reservoir.

When would 96523 apply instead?

96523 describes irrigation of a drug-delivery device, not refill and maintenance of a portable pump. Select based on the service actually performed.

Can clinical staff perform the service?

CMS classifies 96521 as incident-to and permits billing only when the service is performed under physician supervision.

What documentation supports 96521?

Document that the device is a portable pump, the refill and maintenance work performed, and the treatment context. The record should support that the billed service was performed under physician supervision.

Is 96521 the code for starting a prolonged infusion?

No. 96521 describes portable-pump refill and maintenance. Code 96416 describes initiation of a prolonged chemotherapy infusion requiring a pump, when that service is 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

Show the CMS file lines behind this rate
RVUs for 96521PPRRVU2026_Oct_nonQPP.csv, line 12,812 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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