$149.26
Both describe initiation of prolonged chemotherapy infusion using a pump, but 96416 is for intravenous delivery; 96425 is for intra-arterial delivery.
On this page
CMS RVU26D · Effective 2026-10-01
96425 Chemotherapy infusion Medicare reimbursement rates in Guam
Reports initiation of prolonged intra-arterial chemotherapy delivered for more than eight hours through a portable or implantable infusion pump. Compare 96425 office and facility rates across CMS payment localities in Guam.
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 96425 in Guam?
Guam 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
$195.03
1 of 1 localities have a supported rate.
Payment area: Hawaii, Guam
One mapped payment locality.
Facility setting
No supported rate
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 96425: Prolonged intra-arterial chemotherapy infusion
Reports initiation of prolonged intra-arterial chemotherapy delivered for more than eight hours through a portable or implantable infusion pump.
This service covers starting a prolonged chemotherapy infusion into an artery using a portable or implantable pump. It may be used for arterial drug delivery, including liver-directed treatment through an implanted hepatic artery infusion pump. Oncology physicians and supervised clinical staff may provide the service in an outpatient treatment setting when the treatment plan calls for this route and prolonged delivery method.
Select the code when the arterial infusion is initiated and the planned administration exceeds eight hours using the required pump method; an arterial push or shorter infusion has a different code. Document the drug, intra-arterial route, pump method, and infusion plan or duration. The code represents the administration service, rather than the chemotherapy drug itself. Under the CMS rule for this code, it is billed only when performed under physician supervision as an incident-to service.
CMS billing rules for 96425
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.17 · 3%
- Practice expense (office) RVU4.93 · 95%
- Malpractice RVU0.11 · 2%
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.
96425 compared with similar codes
Office rates for Guam, from the same CMS release.
$157.42
96422 describes intra-arterial infusion for up to one hour. Choose 96425 when initiating a pump infusion planned to last more than eight hours.
$84.12
96423 accounts for an additional hour of intra-arterial infusion. 96425 describes initiation of the prolonged pump infusion, not added infusion time.
$117.73
96420 is for intra-arterial chemotherapy given by push technique; 96425 is for prolonged intra-arterial infusion through a pump.
Compare 96425 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
Hawaii, Guam →
Office / nonfacility
$195.03
Facility
Unavailable
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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 96425 in Hawaii, Guam.
PPRRVU2026_Oct_nonQPP.csv
12,808
- Code
- 96425
- Physician work
- 0.17
- Practice expense
- 4.93
- Malpractice
- 0.11
GPCI2026.csv
46
- Locality
- Hawaii, Guam
- Physician work
- 1.000
- Practice expense
- 1.137
- Malpractice
- 0.579
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.17 | × 1.000 | 0.1700 |
| Practice expense | 4.93 | × 1.137 | 5.6054 |
| Malpractice | 0.11 | × 0.579 | 0.0637 |
| Total RVUs | 5.8391 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Hawaii, Guam$195.03
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.17 | 1 |
| Practice expense | 4.93 | 1.137 |
| Malpractice | 0.11 | 0.579 |
(0.17 × 1 + 4.93 × 1.137 + 0.11 × 0.579) × $33.4009 = $195.03
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.
96425 billing questions
When should 96425 be selected instead of an arterial infusion code?
Use 96425 for initiation of a prolonged intra-arterial infusion lasting more than eight hours that requires a portable or implantable pump. Shorter arterial infusions and arterial push administration are reported under different codes.
Does 96425 include the chemotherapy drug?
No. The code represents the administration service; the drug product is reported separately when applicable.
What documentation supports reporting 96425?
Document the intra-arterial route, chemotherapy drug, pump method, and the prolonged infusion plan or duration. The record should support that the infusion was initiated and performed under physician supervision.
Is this code reported for each hour of infusion?
No. 96425 describes initiation of the prolonged pump infusion, not an additional unit for each hour.
Can clinical staff perform the service?
Yes, when performed under physician supervision as an incident-to service, consistent with the CMS rule for this code.
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.
12,80596420,,Chemo ia push tecnique,A,,0.17,2.92,,2.92,NA,0.06,3.15,3.15,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80696422,,Chemo ia infusion up to 1 hr,A,,0.17,3.96,,3.96,NA,0.07,4.20,4.20,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80796423,,Chemo ia infuse each addl hr,A,,0.17,2.04,,2.04,NA,0.05,2.26,2.26,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80896425,,Chemotherapy infusion method,A,,0.17,4.93,,4.93,NA,0.11,5.21,5.21,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80996440,,Chmotx admn plrl cav thrcnts,A,,2.12,20.72,,1.22,,0.14,22.98,3.48,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81096446,,Chemotx admn pertl cav impl,A,,0.37,4.21,,0.08,,0.12,4.70,0.57,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,81196450,,Chemotherapy into cns,A,,1.53,3.15,,0.32,,0.14,4.82,1.99,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503
4410212,GA,01,ATLANTA,1.003,1.016,1.201
4510212,GA,99,REST OF GEORGIA,1.000,0.892,1.192
4601212,HI,01,"HAWAII, GUAM",1.000,1.137,0.579
4702202,ID,00,IDAHO,1.000,0.920,0.473
4806102,IL,16,CHICAGO,1.007,1.005,2.295
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014