Billing code 96405: Intralesional chemotherapyMedicare rate & RVUs in Florida
Report 96405 when an antineoplastic drug is administered directly into one to seven lesions, such as in a dermatology or oncology setting.
Medicare pays $82.10–$88.75 for 96405 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 96405 covers
A physician or other qualified practitioner reports 96405 for administering chemotherapy directly into one or more lesions, with the code covering up to seven lesions. This is a local injection into the lesions, rather than systemic chemotherapy given subcutaneously, intramuscularly, or intravenously. Dermatology and oncology practices commonly provide this service for selected cutaneous lesions; the code represents the administration, not the drug product.
Document the antineoplastic agent, intralesional route, treated sites, and lesion count. Use the code for one through seven lesions; when more than seven are treated, compare the service with 96406. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. Modifier 50 is inappropriate. CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
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 96405 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
$82.10 to $88.75
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $86.17 | $24.59 |
| Miami | $88.75 | $25.47 |
| Rest Of Florida | $82.10 | $23.98 |
How the 96405 rate is calculated
Each of 96405’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 · 96405
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.52Practice expense 1.98Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96405
The CMS indicators that decide how 96405 is paid alongside other services.
CMS payment indicators · 96405
Intralesional chemotherapy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
96405 without 51 · national office
$84.50
Intralesional chemotherapy
96405-51 · Second procedure: 50%
$42.25
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
96405 compared with similar codes
Compare codes
96405 vs 96406 vs 11900 vs 11901 vs 96401: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96406Intralesional chemotherapy
- Both codes cover intralesional chemotherapy. Select 96405 for one through seven lesions and 96406 when more than seven lesions are treated.
- 11900Lesion injection
- Use 96405 for intralesional chemotherapy; 11900 describes intralesional injection of a nonchemotherapy substance for up to seven lesions.
- 11901Lesion injection
- Use 96405 for chemotherapy into up to seven lesions. Code 11901 is for nonchemotherapy intralesional injection when more than seven lesions are treated.
- 96401Chemotherapy injection
- Both involve chemotherapy administration, but 96401 is for subcutaneous or intramuscular delivery; 96405 is for injection directly into lesions.
96405 billing questions
How many lesions can be reported with 96405?
96405 covers administration into one through seven lesions. For treatment of more than seven lesions, compare the service with 96406 rather than reporting 96405 for every lesion.
How is 96405 different from 11900?
96405 is for intralesional chemotherapy. Code 11900 is for intralesional injection of a substance other than chemotherapy, for up to seven lesions.
Is the chemotherapy drug included in 96405?
No. The code represents administration; report a separately payable drug product under its applicable code when the practice supplies it and documentation supports separate reporting.
Should modifier 50 be used when lesions are on both sides?
No. CMS identifies bilateral adjustment as inappropriate for 96405. Report the service based on the number of treated lesions, not as a bilateral procedure.
What documentation supports 96405?
Record the drug, intralesional route, lesion locations, and number of lesions treated. The count supports choosing 96405 for up to seven lesions or 96406 for more than seven.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction. CMS does not pay an assistant at surgery for 96405.
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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