CPT code 96542: CNS chemotherapy2026 Medicare rate & RVUs in Illinois
Report this service when antineoplastic medication is administered into the central nervous system through an implanted reservoir, such as an Ommaya reservoir.
Medicare pays $126.07–$138.89 for 96542 in the office in Illinois, from Rest Of Illinois to Suburban Chicago. 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 96542 covers
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.
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 96542 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$126.07 to $138.89
| Payment locality | Office | Facility |
|---|---|---|
| Chicago | $137.58 | $38.55 |
| East St. Louis | $127.73 | $37.08 |
| Rest Of Illinois | $126.07 | $36.11 |
| Suburban Chicago | $138.89 | $37.70 |
How the 96542 rate is calculated
Each of 96542’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 · 96542
RVUs × geographic indexes × conversion factor
Work0.75
0.75 RVUs× 1.000 GPCI
Practice expense3.21
3.21 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
4.0200
Conversion factor
$33.4009
Medicare rate
$134.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96542
96542 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 96542
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$134.27
- Non-facility (office)
- $134.27
- Facility
- $35.74
Higher because the practice carries its own overhead.
96542 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 96450Chemotherapy administration
- Both involve CNS chemotherapy, but 96542 is for administration through an implanted reservoir; 96450 is for administration requiring spinal puncture.
- 96523Irrig drug delivery device
- This code describes irrigation of an implanted drug-delivery access device, not CNS chemotherapy administration through a reservoir.
- 96549Unlisted 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.
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 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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