$159.51
Both involve CNS chemotherapy, but 96542 is for administration through an implanted reservoir; 96450 is for administration requiring spinal puncture.
On this page
CMS RVU26D · Effective 2026-10-01
96542 CNS chemotherapy Medicare reimbursement rates in Delaware
Report this service when antineoplastic medication is administered into the central nervous system through an implanted reservoir, such as an Ommaya reservoir. Compare 96542 office and facility rates across CMS payment localities in Delaware.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 96542 in Delaware?
Delaware has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$132.91
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
Facility setting
$35.56
1 of 1 localities have a supported rate.
Payment area: Delaware
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Chemotherapy administration
About 96542: CNS chemotherapy through implanted reservoir
Report this service when antineoplastic medication is administered into the central nervous system through an implanted reservoir, such as an Ommaya reservoir.
This service covers delivery of antineoplastic medication into the cerebrospinal fluid or ventricular system through an implanted reservoir. It is commonly performed by an oncologist, neuro-oncologist, or other qualified clinician treating a patient who needs CNS-directed chemotherapy and has an access reservoir in place. An Ommaya reservoir is a typical example; the defining feature is administration through the reservoir rather than by a spinal puncture.
Select the code when the record supports CNS chemotherapy administered through that access route. Document the medication, dose, administration date, and route through the reservoir, along with the clinical indication. Distinguish the drug administration from routine device care or irrigation, and do not select the code solely because a reservoir is present. This service is not time-based; the documentation should establish the administration performed.
Where the value comes from
- Work RVU0.75 · 19%
- Practice expense (office) RVU3.21 · 80%
- Malpractice RVU0.06 · 1%
1.2K
Medicare services in 2024 · #2819 by national volume
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.
96542 compared with similar codes
Office rates for Delaware, from the same CMS release.
96523
No office rateIrrig drug delivery device
This code describes irrigation of an implanted drug-delivery access device, not CNS chemotherapy administration through a reservoir.
96549
No office rateUnlisted chemotherapy px
Use 96549 for an unlisted chemotherapy procedure when no specific code describes the service; 96542 specifically identifies CNS drug administration through a reservoir.
Compare 96542 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Delaware →
Office / nonfacility
$132.91
Facility
$35.56
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96542 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
12,815
- Code
- 96542
- Physician work
- 0.75
- Practice expense
- 3.21
- Malpractice
- 0.06
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.005 | 0.7537 |
| Practice expense | 3.21 | × 0.988 | 3.1715 |
| Malpractice | 0.06 | × 0.899 | 0.0539 |
| Total RVUs | 3.9792 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Delaware$132.91
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1.005 |
| Practice expense | 3.21 | 0.988 |
| Malpractice | 0.06 | 0.899 |
(0.75 × 1.005 + 3.21 × 0.988 + 0.06 × 0.899) × $33.4009 = $132.91
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1.005 |
| Practice expense | 0.26 | 0.988 |
| Malpractice | 0.06 | 0.899 |
(0.75 × 1.005 + 0.26 × 0.988 + 0.06 × 0.899) × $33.4009 = $35.56
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
96542 billing questions
How does this differ from 96450?
Use 96542 for CNS chemotherapy administered through an implanted reservoir. Code 96450 describes CNS chemotherapy delivered by spinal puncture.
Does this code describe reservoir maintenance?
No. It represents administration of antineoplastic medication through the reservoir, not routine maintenance or irrigation alone.
What documentation supports reporting 96542?
Record the medication and dose, the CNS indication, and that the drug was administered through the implanted reservoir.
Is the service reported by time?
No. The service is not time-based; document the administration performed rather than elapsed treatment time.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,81296521,,Refill/maint portable pump,A,,0.21,4.02,,4.02,NA,0.07,4.30,4.30,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81396522,,Refill/maint pump/resvr syst,A,,0.21,3.47,,3.47,NA,0.07,3.75,3.75,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81496523,,Irrig drug delivery device,T,,0.04,0.73,,0.73,NA,0.01,0.78,0.78,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81596542,,Chemotherapy injection,A,,0.75,3.21,,0.26,,0.06,4.02,1.07,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81696547,,Intraop hipec px 1st 60 min,A,,6.53,1.82,NA,1.82,,1.52,9.87,9.87,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81796548,,Ntraop hipec px ea add 30min,A,,3.00,0.85,NA,0.85,,0.69,4.54,4.54,0,ZZZ,0.00,0.00,0.00,0,0,2,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81896549,,Unlisted chemotherapy px,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503