CPT code 96521: Pump refill, portable infusion pump2026 Medicare rate & RVUs in New York
Reports refilling and maintaining a portable infusion pump used to deliver medication over time, when the pump service is performed under physician supervision.
Medicare pays $136.22–$171.45 for 96521 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. 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 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.
Where 96521 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$136.22 to $171.45
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $167.19 | Unavailable |
| NYC suburbs and Long Island, NY | $171.45 | Unavailable |
| Poughkeepsie and northern NYC suburbs, NY | $157.19 | Unavailable |
| Queens, NY | $169.54 | Unavailable |
| Rest of New York | $136.22 | Unavailable |
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
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.
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
| 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. |
96521 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96522Pump refillImplantable systemic delivery
- Choose 96521 for a portable pump; choose 96522 when refilling and maintaining an implanted pump or reservoir.
- 96523Port irrigationImplanted drug-delivery access device
- 96523 describes irrigation of a drug-delivery device. It does not describe refilling and maintaining a portable infusion pump.
- 96416Pump infusionProlonged infusion over eight hours
- 96416 reports initiation of a prolonged chemotherapy infusion requiring a pump; 96521 reports portable-pump refill and maintenance.
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.
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