$35.65
96402 is for hormonal antineoplastics such as leuprolide, goserelin, or fulvestrant; 96401 is for qualifying nonhormonal agents such as bortezomib or azacitidine.
On this page
CMS RVU26D · Effective 2026-10-01
96401 Chemotherapy injection Medicare reimbursement rates in Iowa
Report 96401 when a qualifying nonhormonal antineoplastic drug, such as bortezomib or azacitidine, is administered by subcutaneous or intramuscular injection. Compare 96401 office and facility rates across CMS payment localities in Iowa.
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 96401 in Iowa?
Iowa 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
$65.61
1 of 1 localities have a supported rate.
Payment area: Iowa
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 96401: Nonhormonal chemotherapy injection, subcutaneous or intramuscular
Report 96401 when a qualifying nonhormonal antineoplastic drug, such as bortezomib or azacitidine, is administered by subcutaneous or intramuscular injection.
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.
CMS billing rules for 96401
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.21 · 10%
- Practice expense (office) RVU1.90 · 88%
- Malpractice RVU0.04 · 2%
937.5K
Medicare services in 2024 · #150 by national volume
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.
96401 compared with similar codes
Office rates for Iowa, from the same CMS release.
$14.37
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.
$95.30
96409 is for an antineoplastic drug given by IV push; 96401 applies to qualifying subcutaneous or intramuscular injection.
$78.28
96405 is for chemotherapy injected directly into up to seven lesions; 96401 is for a qualifying subcutaneous or intramuscular injection rather than intralesional delivery.
Compare 96401 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
Iowa →
Office / nonfacility
$65.61
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 96401 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
12,795
- Code
- 96401
- Physician work
- 0.21
- Practice expense
- 1.90
- Malpractice
- 0.04
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.21 | × 1.000 | 0.2100 |
| Practice expense | 1.90 | × 0.915 | 1.7385 |
| Malpractice | 0.04 | × 0.397 | 0.0159 |
| Total RVUs | 1.9644 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Iowa$65.61
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.21 | 1 |
| Practice expense | 1.9 | 0.915 |
| Malpractice | 0.04 | 0.397 |
(0.21 × 1 + 1.9 × 0.915 + 0.04 × 0.397) × $33.4009 = $65.61
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.
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 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.
12,79296379,,Unl ther/prop/diag inj/inf,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79396380,,Admn rsv monoc antb im cnsl,A,,0.28,0.60,,0.60,NA,0.02,0.90,0.90,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79496381,,Admn rsv monoc antb im njx,A,,0.17,0.55,,0.55,NA,0.01,0.73,0.73,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79596401,,Chemo anti-neopl sq/im,A,,0.21,1.90,,1.90,NA,0.04,2.15,2.15,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79696402,,Chemo hormon antineopl sq/im,A,,0.19,0.95,,0.95,NA,0.02,1.16,1.16,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79796405,,Chemo intralesional up to 7,A,,0.52,1.98,,0.16,,0.03,2.53,0.71,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79896406,,Chemo intralesional over 7,A,,0.80,3.09,,0.26,,0.06,3.95,1.12,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136