Billing code 96521: Pump refillMedicare rate & RVUs
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 $143.62 for 96521 nationally in the office. Local office rates run $123.56–$202.66.
Medicare rate · 96521
Pump refill
Swap in your local Medicare rate.
- Work RVUs
- 0.21
- Total RVUs
- 4.30
- Global days
- XXX
National rate · 2026
$143.62
Office setting, before claim adjustments.
See every locality for 96521 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$123.56 to $202.66
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $125.83 | Unavailable |
| Alaska* | $154.81 | Unavailable |
| Arizona | $139.12 | Unavailable |
| Arkansas | $123.56 | Unavailable |
| Atlanta | $146.26 | Unavailable |
| Austin | $151.16 | Unavailable |
| Bakersfield | $155.73 | Unavailable |
| Baltimore/Surr. Cntys | $154.09 | Unavailable |
| Beaumont | $131.37 | Unavailable |
| Brazoria | $141.96 | Unavailable |
| Chicago | $147.37 | Unavailable |
| Chico | $155.55 | Unavailable |
| Colorado | $151.79 | Unavailable |
| Connecticut | $154.59 | Unavailable |
| Dallas | $142.82 | Unavailable |
| Dc + Md/Va Suburbs | $168.17 | Unavailable |
| Delaware | $141.81 | Unavailable |
| Detroit | $140.53 | Unavailable |
| East St. Louis | $135.25 | Unavailable |
| El Centro | $155.56 | Unavailable |
| Fort Lauderdale | $147.26 | Unavailable |
| Fort Worth | $141.51 | Unavailable |
| Fresno | $155.55 | Unavailable |
| Galveston | $142.34 | Unavailable |
| Hanford-Corcoran | $155.55 | Unavailable |
| Hawaii, Guam | $161.03 | Unavailable |
| Houston | $143.62 | Unavailable |
| Idaho | $131.65 | Unavailable |
| Indiana | $132.62 | Unavailable |
| Iowa | $130.80 | Unavailable |
| Kansas | $129.57 | Unavailable |
| Kentucky | $128.52 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $167.70 | Unavailable |
| Madera | $155.55 | Unavailable |
| Manhattan | $167.19 | Unavailable |
| Merced | $155.55 | Unavailable |
| Metropolitan Boston | $169.70 | Unavailable |
| Metropolitan Kansas City | $135.38 | Unavailable |
| Metropolitan Philadelphia | $149.71 | Unavailable |
| Metropolitan St. Louis | $137.18 | Unavailable |
| Miami | $152.70 | Unavailable |
| Minnesota | $145.87 | Unavailable |
| Mississippi | $124.35 | Unavailable |
| Modesto | $155.55 | Unavailable |
| Montana** | $143.62 | Unavailable |
| Napa | $185.61 | Unavailable |
| Nebraska | $131.83 | Unavailable |
| Nevada** | $143.37 | Unavailable |
| New Hampshire | $148.84 | Unavailable |
| New Mexico | $132.95 | Unavailable |
| New Orleans | $136.02 | Unavailable |
| North Carolina | $133.78 | Unavailable |
| North Dakota** | $142.24 | Unavailable |
| Northern Nj | $165.71 | Unavailable |
| Nyc Suburbs/Long Island | $171.45 | Unavailable |
| Ohio | $131.96 | Unavailable |
| Oklahoma | $128.74 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $167.38 | Unavailable |
| Portland | $158.04 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $157.19 | Unavailable |
| Puerto Rico | $145.07 | Unavailable |
| Queens | $169.54 | Unavailable |
| Redding | $155.55 | Unavailable |
| Rest Of California | $155.55 | Unavailable |
| Rest Of Florida | $138.89 | Unavailable |
| Rest Of Georgia | $129.57 | Unavailable |
| Rest Of Illinois | $133.26 | Unavailable |
| Rest Of Louisiana | $128.08 | Unavailable |
| Rest Of Maine | $132.00 | Unavailable |
| Rest Of Maryland | $145.11 | Unavailable |
| Rest Of Massachusetts | $150.38 | Unavailable |
| Rest Of Michigan | $132.24 | Unavailable |
| Rest Of Missouri | $125.03 | Unavailable |
| Rest Of New Jersey | $156.48 | Unavailable |
| Rest Of New York | $136.22 | Unavailable |
| Rest Of Oregon | $142.39 | Unavailable |
| Rest Of Pennsylvania | $132.49 | Unavailable |
| Rest Of Texas | $136.55 | Unavailable |
| Rest Of Washington | $150.27 | Unavailable |
| Rhode Island | $147.94 | Unavailable |
| Riverside-San Bernardino-Ontario | $156.30 | Unavailable |
| Sacramento-Roseville-Folsom | $164.68 | Unavailable |
| Salinas | $164.11 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $169.08 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $198.08 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $198.00 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $202.66 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $202.33 | Unavailable |
| San Luis Obispo-Paso Robles | $161.32 | Unavailable |
| Santa Cruz-Watsonville | $171.55 | Unavailable |
| Santa Maria-Santa Barbara | $165.02 | Unavailable |
| Santa Rosa-Petaluma | $173.36 | Unavailable |
| Seattle (King Cnty) | $174.03 | Unavailable |
| South Carolina | $133.07 | Unavailable |
| South Dakota** | $142.07 | Unavailable |
| Southern Maine | $141.55 | Unavailable |
| Stockton | $155.55 | Unavailable |
| Suburban Chicago | $149.10 | Unavailable |
| Tennessee | $130.32 | Unavailable |
| Utah | $135.33 | Unavailable |
| Vallejo | $185.50 | Unavailable |
| Vermont | $141.13 | Unavailable |
| Virgin Islands | $145.07 | Unavailable |
| Virginia | $140.65 | Unavailable |
| Visalia | $155.55 | Unavailable |
| West Virginia | $127.04 | Unavailable |
| Wisconsin | $136.37 | Unavailable |
| Wyoming** | $143.02 | Unavailable |
| Yuba City | $155.55 | Unavailable |
96521 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $154.81 | 1 |
| AL | $125.83 | 1 |
| AR | $123.56 | 1 |
| AZ | $139.12 | 1 |
| CA | $155.55–$202.66 | 29 |
| CO | $151.79 | 1 |
| CT | $154.59 | 1 |
| DC | $168.17 | 1 |
| DE | $141.81 | 1 |
| FL | $138.89–$152.70 | 3 |
| GA | $129.57–$146.26 | 2 |
| GU | $161.03 | 1 |
| HI | $161.03 | 1 |
| IA | $130.80 | 1 |
| ID | $131.65 | 1 |
| IL | $133.26–$149.10 | 4 |
| IN | $132.62 | 1 |
| KS | $129.57 | 1 |
| KY | $128.52 | 1 |
| LA | $128.08–$136.02 | 2 |
| MA | $150.38–$169.70 | 2 |
| MD | $145.11–$168.17 | 3 |
| ME | $132.00–$141.55 | 2 |
| MI | $132.24–$140.53 | 2 |
| MN | $145.87 | 1 |
| MO | $125.03–$137.18 | 3 |
| MS | $124.35 | 1 |
| MT | $143.62 | 1 |
| NC | $133.78 | 1 |
| ND | $142.24 | 1 |
| NE | $131.83 | 1 |
| NH | $148.84 | 1 |
| NJ | $156.48–$165.71 | 2 |
| NM | $132.95 | 1 |
| NV | $143.37 | 1 |
| NY | $136.22–$171.45 | 5 |
| OH | $131.96 | 1 |
| OK | $128.74 | 1 |
| OR | $142.39–$158.04 | 2 |
| PA | $132.49–$149.71 | 2 |
| PR | $145.07 | 1 |
| RI | $147.94 | 1 |
| SC | $133.07 | 1 |
| SD | $142.07 | 1 |
| TN | $130.32 | 1 |
| TX | $131.37–$151.16 | 8 |
| UT | $135.33 | 1 |
| VA | $140.65–$168.17 | 2 |
| VI | $145.07 | 1 |
| VT | $141.13 | 1 |
| WA | $150.27–$174.03 | 2 |
| WI | $136.37 | 1 |
| WV | $127.04 | 1 |
| WY | $143.02 | 1 |
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
Swap in your local Medicare rate.
Work 0.21Practice expense 4.02Malpractice 0.07
All indexes start 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
| 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
96521 vs 96522 vs 96523 vs 96416: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96522Pump refill
- Choose 96521 for a portable pump; choose 96522 when refilling and maintaining an implanted pump or reservoir.
- 96523Irrig drug delivery device
- 96523 describes irrigation of a drug-delivery device. It does not describe refilling and maintaining a portable infusion pump.
- 96416Pump infusion
- 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.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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