$122.66–$131.31
Choose 96416 for an intravenous chemotherapy infusion lasting more than eight hours through a portable or implantable pump. Code 96413 represents a shorter infusion service.
On this page
CMS RVU26D · Effective 2026-10-01
96416 Pump infusion Medicare reimbursement rates in Maine
Reports initiation of intravenous chemotherapy delivered for more than eight hours through a portable or implantable pump. Compare 96416 office and facility rates across CMS payment localities in Maine.
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 96416 in Maine?
Maine has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$122.47–$131.29
2 of 2 localities have a supported rate.
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 96416: Prolonged IV chemotherapy pump initiation
Reports initiation of intravenous chemotherapy delivered for more than eight hours through a portable or implantable pump.
This service covers starting an intravenous chemotherapy infusion intended to continue for more than eight hours using a portable or implantable pump. It is commonly initiated by oncology staff in an office infusion clinic, with the patient continuing the infusion outside the clinic. The pump may be portable or implanted; the defining features are the prolonged infusion and pump-based delivery.
Report 96416 for starting the qualifying infusion, not for each hour the pump continues to deliver medication. Documentation should identify the chemotherapy drug, intravenous route, pump use, and infusion duration, and support that the service was initiated. The chemotherapy drug is reported separately when applicable. CMS treats this as an incident-to service: it may be billed only when performed under physician supervision.
CMS billing rules for 96416
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.21 · 5%
- Practice expense (office) RVU3.71 · 93%
- Malpractice RVU0.07 · 2%
23K
Medicare services in 2024 · #1088 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.
96416 compared with similar codes
Office rates for Maine, from the same CMS release.
$26.43–$27.95
Code 96415 represents an additional infusion hour. Code 96416 reports initiation of a prolonged pump-based infusion, rather than successive hourly increments.
$61.41–$65.57
Code 96417 describes a distinct sequential infusion of another chemotherapy drug. It does not represent initiation of the prolonged pump infusion itself.
$159.46–$171.18
Both codes describe prolonged pump-based chemotherapy infusion, but 96425 is for the intra-arterial route; 96416 is for intravenous administration.
Compare 96416 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.
2 of 2 payment localities
Rest Of Maine →
Office / nonfacility
$122.47
Facility
Unavailable
Southern Maine →
Office / nonfacility
$131.29
Facility
Unavailable
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96416 billing questions
When should 96416 be used instead of 96413?
Use 96416 when intravenous chemotherapy is initiated for an infusion lasting more than eight hours through a portable or implantable pump. Code 96413 describes a shorter intravenous infusion service.
Is 96416 reported for every hour of pump delivery?
No. It reports initiation of the prolonged pump infusion, not repeated hourly increments.
Is the chemotherapy drug included in 96416?
The code reports the administration service. Report the chemotherapy drug separately when applicable.
What documentation supports 96416?
Document the drug, intravenous route, use of a portable or implantable pump, infusion duration, and initiation of the infusion.
What supervision is required for Medicare billing?
CMS identifies 96416 as an incident-to service. It may be billed only when performed under physician supervision.
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.
12,80096411,,Chemo iv push addl drug,A,,0.20,1.48,,1.48,NA,0.03,1.71,1.71,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80196413,,Chemo iv infusion 1 hr,A,,0.28,3.64,,3.64,NA,0.07,3.99,3.99,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80296415,,Chemo iv infusion addl hr,A,,0.19,0.64,,0.64,NA,0.02,0.85,0.85,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80396416,,Chemo prolong infuse w/pump,A,,0.21,3.71,,3.71,NA,0.07,3.99,3.99,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80496417,,Chemo iv infus each addl seq,A,,0.21,1.75,,1.75,NA,0.03,1.99,1.99,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80596420,,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