CPT code 96523: Port irrigation, implanted drug-delivery access device2026 Medicare rate & RVUs in Illinois
Report this service when an implanted venous access device used for drug delivery is irrigated or flushed to maintain access-device function.
Medicare pays $24.12–$26.98 for 96523 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. 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.
Your location
On this page 9 sections
What 96523 covers
This service covers irrigation or flushing of an implanted venous access device used to deliver drugs, such as an implanted port. Clinical staff typically perform it in an office or outpatient setting as ongoing device maintenance, rather than to refill a medication pump or administer a drug. The work centers on accessing and irrigating the device; it is not port placement or removal.
Select the code when documentation supports irrigation of the implanted access device, not refill or maintenance of a portable or implanted pump. The record should identify the device and describe the irrigation performed. CMS treats this as an injection or minor service and pays it only when no other physician service is billed on the same date. It is an incident-to service, so 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 96523 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$24.12 to $26.98
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $26.62 | Unavailable |
| East St. Louis, IL | $24.44 | Unavailable |
| Rest of Illinois | $24.12 | Unavailable |
| Suburban Chicago, IL | $26.98 | Unavailable |
How the 96523 rate is calculated
Each of 96523’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 · 96523
RVUs × geographic indexes × conversion factor
Work0.04
0.04 RVUs× 1.000 GPCI
Practice expense0.73
0.73 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.7800
Conversion factor
$33.4009
Medicare rate
$26.05
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96523
The CMS indicators that decide how 96523 is paid alongside other services.
CMS payment indicators · 96523
Port irrigation, implanted drug-delivery access device
| 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. |
96523 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96521Pump refillPortable infusion pump
- Choose 96521 for refill or maintenance of a portable pump. Choose 96523 for irrigation of an implanted venous access device.
- 96522Pump refillImplantable systemic delivery
- Choose 96522 for refill or maintenance of an implanted pump or reservoir; 96523 is for irrigation of an implanted venous access device.
- 36591Port blood drawImplantable venous access device
- 36591 describes collection of a blood specimen from a completely implantable venous access device. It does not describe irrigation or flushing of that device.
96523 billing questions
When should 96523 be used instead of 96522?
Use 96523 for irrigation of an implanted venous access device used for drug delivery. Use 96522 for refill or maintenance of an implanted pump or reservoir system.
Can 96523 be paid when another physician service is billed that day?
Under the CMS rule supplied for this code, payment is available only when no other physician service is billed on the same date.
What documentation supports 96523?
Document that the device is an implanted venous access device used for drug delivery and that irrigation or flushing was performed. The record should also support that the service was provided under physician supervision.
Does 96523 describe a medication pump refill?
No. It describes irrigation of an implanted access device; pump refill or maintenance is represented by a different code, depending on the pump.
Can a modifier make 96523 payable with another physician service?
A modifier does not override the CMS payment condition supplied for this code: payment is available only when no other physician service is billed on the same date.
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
Fee sheets · Coming soon
Put 96523 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist