CPT code 96413: Chemo IV infusion2026 Medicare rate & RVUs

Medicare pays $133.27 for 96413 nationally in the office. Local office rates run $114.99–$186.95.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96413 covers

Code 96413 captures the initial hour of an intravenous antineoplastic infusion or an infusion of another agent that meets chemotherapy administration requirements for high-complexity biologic therapy. Oncology nurses commonly administer these treatments in physician offices or outpatient infusion suites under an oncologist’s or hematologist’s supervision. Paclitaxel or carboplatin infusions are familiar examples. Nursing work includes preparing the infusion, assessing the patient, monitoring for reactions, and ending the infusion; classification as a monoclonal antibody alone does not establish eligibility for chemotherapy administration coding.

Report one initial administration service per encounter unless separate medically necessary IV sites support distinct initial services. Record the drug and actual start and stop times; infusion lasting more than 15 minutes supports 96413, and 96415 begins only when the infusion exceeds 90 minutes. Sequential chemotherapy drugs and separately administered premedications or hydration may support additional administration codes when their requirements are met. The IV start, routine flush, and usual supplies are included; report separately payable drug products with appropriate HCPCS codes. CMS classifies 96413 as an incident-to service, 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 96413 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96413 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 96413 rate is calculated

Each of 96413’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.

Payment rules and modifiers for 96413

The CMS indicators that decide how 96413 is paid alongside other services.

96413 compared with similar codes

How to choose

96409Chemotherapy push

96409 describes an antineoplastic IV push, including drug administration lasting 15 minutes or less. Use 96413 for a qualifying infusion lasting more than 15 minutes; document its start and stop times.

96365IV drug infusion

96365 is the initial IV infusion of a drug that does not meet chemotherapy administration requirements, such as an antibiotic. Use 96413 for an antineoplastic or other agent that qualifies for high-complexity chemotherapy administration.

96417Chemotherapy infusion

96417 is an add-on for a different chemotherapy drug infused sequentially after the initial drug. Use 96413 for the initial chemotherapy infusion of the encounter.

96416Pump infusion

96416 describes initiation of a prolonged chemotherapy infusion lasting more than eight hours through a portable or implantable pump. Use 96413 for the initial hour of a directly administered IV infusion.

Codes related to 96413

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

Open CMS sourceHow we calculate rates