Billing code 96416: Pump infusionMedicare rate & RVUs

Medicare pays $133.27 for 96416 nationally in the office. Local office rates run $114.66–$187.73.

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

What 96416 covers

This service covers starting an intravenous chemotherapy infusion intended to continue for more than eight hours using a portable or implantable pump. It is commonly initiated by oncology staff in an office infusion clinic, with the patient continuing the infusion outside the clinic. The pump may be portable or implanted; the defining features are the prolonged infusion and pump-based delivery.

Report 96416 for starting the qualifying infusion, not for each hour the pump continues to deliver medication. Documentation should identify the chemotherapy drug, intravenous route, pump use, and infusion duration, and support that the service was initiated. The chemotherapy drug is reported separately when applicable. CMS treats this 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 96416 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

96416 rates by state

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

How the 96416 rate is calculated

Each of 96416’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 96416

The CMS indicators that decide how 96416 is paid alongside other services.

96416 compared with similar codes

How to choose

96413Chemo IV infusion

Choose 96416 for an intravenous chemotherapy infusion lasting more than eight hours through a portable or implantable pump. Code 96413 represents a shorter infusion service.

96415Chemo infusion add-on

Code 96415 represents an additional infusion hour. Code 96416 reports initiation of a prolonged pump-based infusion, rather than successive hourly increments.

96417Chemotherapy infusion

Code 96417 describes a distinct sequential infusion of another chemotherapy drug. It does not represent initiation of the prolonged pump infusion itself.

96425Chemotherapy infusion

Both codes describe prolonged pump-based chemotherapy infusion, but 96425 is for the intra-arterial route; 96416 is for intravenous administration.

Codes related to 96416

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