CPT code 96406: Intralesional chemotherapy2026 Medicare rate & RVUs in Florida
Reports administration of antineoplastic medication directly into more than seven lesions during treatment of multiple localized lesions.
Medicare pays $128.40–$139.23 for 96406 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 96406 covers
This service covers delivery of an antineoplastic medication directly into more than seven discrete lesions. Dermatology and oncology clinicians may perform it in an office or other treatment setting when lesions are treated individually by the intralesional route. The code reflects the number of lesions treated, not the number of injections, syringes, or medications used. It is distinct from systemic chemotherapy delivered by subcutaneous, intramuscular, intravenous, or other routes.
Select the code based on the documented lesion count: this level is for more than seven treated lesions, while 96405 is the lower-count sibling. Record the lesions treated, their sites, the medication, and the intralesional route. The medication is separate from the administration service when separately reportable. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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; assistant-at-surgery payment is restricted, 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 96406 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
$128.40 to $139.23
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $134.89 | $39.14 |
| Miami | $139.23 | $40.83 |
| Rest Of Florida | $128.40 | $38.03 |
How the 96406 rate is calculated
Each of 96406’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 · 96406
RVUs × geographic indexes × conversion factor
Work0.80
0.80 RVUs× 1.000 GPCI
Practice expense3.09
3.09 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
3.9500
Conversion factor
$33.4009
Medicare rate
$131.93
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96406
The CMS indicators that decide how 96406 is paid alongside other services.
CMS payment indicators · 96406
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
96406 without 51 · national office
$131.93
Intralesional chemotherapy
96406-51 · Second procedure: 50%
$65.97
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%).
96406 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96405Intralesional chemotherapy
- Both describe intralesional chemotherapy administration. Choose 96406 when more than seven lesions are treated; 96405 is for seven or fewer.
- 96401Chemotherapy injection
- 96401 describes antineoplastic administration by the subcutaneous or intramuscular route. This code is for medication injected directly into more than seven lesions.
- 96409Chemotherapy push
- 96409 is for antineoplastic medication given by intravenous push. This code applies to direct intralesional treatment of more than seven lesions.
96406 billing questions
How is this code distinguished from 96405?
Use this code when more than seven lesions are treated intralesionally. Use 96405 for seven or fewer treated lesions.
Are units based on injections or lesions?
The threshold is based on the number of lesions treated, not the number of needle entries or syringes. Document the treated lesion count and sites.
Is the antineoplastic medication included?
This code reports the administration service, not the medication itself. Report the drug separately when it is separately reportable.
Can modifier 50 be used for lesions on both sides?
No. CMS identifies modifier 50 as inappropriate for this service; treatment of lesions on both sides does not make it a bilateral procedure.
How does the same-session multiple-procedure rule affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
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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