Billing code 96401: Chemotherapy injectionMedicare rate & RVUs in Florida
Report 96401 when a qualifying nonhormonal antineoplastic drug, such as bortezomib or azacitidine, is administered by subcutaneous or intramuscular injection.
Medicare pays $69.69–$76.46 for 96401 in the office in Florida, from Rest Of Florida to Miami. 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.
On this page 9 sections
What 96401 covers
Trained oncology staff administer nonhormonal antineoplastic medication beneath the skin or into muscle, most often in a physician's oncology or hematology office. Examples include subcutaneous bortezomib for multiple myeloma and azacitidine for myelodysplastic syndromes; qualifying subcutaneous antibody formulations include daratumumab with hyaluronidase. Nursing work includes verifying the agent and dose, administering the injection, and monitoring the patient for a reaction.
Choose 96401 for qualifying subcutaneous or intramuscular nonhormonal antineoplastic administration, rather than hormonal injections under 96402 or routine therapeutic injections under 96372. The administration is separate from the drug supply, which is reported with its appropriate HCPCS code and documented dose. Record the medication, dose, route, injection site, date, and supervising physician. CMS classifies 96401 as an incident-to service; billing under the physician requires physician supervision. A significant, separately identifiable E/M service may be reported with modifier 25 on the E/M code when documentation supports work beyond the injection encounter.
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 96401 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$69.69 to $76.46
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $73.72 | Unavailable |
| Miami | $76.46 | Unavailable |
| Rest Of Florida | $69.69 | Unavailable |
How the 96401 rate is calculated
Each of 96401’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 · 96401
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.21Practice expense 1.90Malpractice 0.04
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96401
The CMS indicators that decide how 96401 is paid alongside other services.
CMS payment indicators · 96401
Chemotherapy injection
| 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. |
96401 compared with similar codes
Compare codes
96401 vs 96402 vs 96372 vs 96409 vs 96405: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96402Hormonal therapy injection
- 96402 is for hormonal antineoplastics such as leuprolide, goserelin, or fulvestrant; 96401 is for qualifying nonhormonal agents such as bortezomib or azacitidine.
- 96372SC/IM injection
- 96372 covers routine SC/IM therapeutic injections, including methotrexate given for rheumatoid arthritis. Use 96401 when a nonhormonal SC/IM injection qualifies as chemotherapy administration.
- 96409Chemotherapy push
- 96409 is for an antineoplastic drug given by IV push; 96401 applies to qualifying subcutaneous or intramuscular injection.
- 96405Intralesional chemotherapy
- 96405 is for chemotherapy injected directly into up to seven lesions; 96401 is for a qualifying subcutaneous or intramuscular injection rather than intralesional delivery.
96401 billing questions
When is 96402 reported instead of 96401?
Use 96402 when the injected antineoplastic is hormonal, such as leuprolide, goserelin, or fulvestrant. Nonhormonal agents such as bortezomib or azacitidine are reported with 96401 when administered subcutaneously or intramuscularly.
Can 96401 be used for methotrexate given to a rheumatoid arthritis patient?
Methotrexate and a rheumatoid arthritis diagnosis alone do not establish chemotherapy administration. A routine subcutaneous or intramuscular therapeutic injection is reported with 96372; use 96401 only when the service qualifies as chemotherapy administration.
Is the drug included in 96401?
No. Report the drug separately with its applicable HCPCS code, such as J9041 for bortezomib or J9025 for azacitidine, using units supported by the documented dose.
Can an E/M visit be billed on the same day?
A significant, separately identifiable E/M service may be reported when documentation supports work beyond the injection encounter; append modifier 25 to the E/M code. Do not separately report a nurse-only 99211 visit for the chemotherapy administration.
What supervision is required in the office?
CMS classifies 96401 as an incident-to service. The injection must be performed under physician supervision to be billed under the physician.
When does 96372 apply instead of 96401?
Use 96372 for a routine subcutaneous or intramuscular therapeutic injection, such as vitamin B12, ceftriaxone, or methotrexate given for rheumatoid arthritis. Use 96401 when the nonhormonal injection qualifies as chemotherapy administration.
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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