$142.69–$150.27
Both codes cover intralesional chemotherapy. Select 96405 for one through seven lesions and 96406 when more than seven lesions are treated.
On this page
CMS RVU26D · Effective 2026-10-01
96405 Intralesional chemotherapy Medicare reimbursement rates in New Jersey
Report 96405 when an antineoplastic drug is administered directly into one to seven lesions, such as in a dermatology or oncology setting. Compare 96405 office and facility rates across CMS payment localities in New Jersey.
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 96405 in New Jersey?
New Jersey 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
$91.38–$96.25
2 of 2 localities have a supported rate.
Facility setting
$25.00–$25.73
2 of 2 localities have a 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 96405: Intralesional chemotherapy for up to seven lesions
Report 96405 when an antineoplastic drug is administered directly into one to seven lesions, such as in a dermatology or oncology setting.
A physician or other qualified practitioner reports 96405 for administering chemotherapy directly into one or more lesions, with the code covering up to seven lesions. This is a local injection into the lesions, rather than systemic chemotherapy given subcutaneously, intramuscularly, or intravenously. Dermatology and oncology practices commonly provide this service for selected cutaneous lesions; the code represents the administration, not the drug product.
Document the antineoplastic agent, intralesional route, treated sites, and lesion count. Use the code for one through seven lesions; when more than seven are treated, compare the service with 96406. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures are performed 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. CMS does not pay an assistant at surgery for this service, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 96405
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU0.52 · 21%
- Practice expense (office) RVU1.98 · 78%
- Malpractice RVU0.03 · 1%
30.7K
Medicare services in 2024 · #969 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.
96405 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$61.13–$64.06
Use 96405 for intralesional chemotherapy; 11900 describes intralesional injection of a nonchemotherapy substance for up to seven lesions.
$73.79–$77.07
Use 96405 for chemotherapy into up to seven lesions. Code 11901 is for nonchemotherapy intralesional injection when more than seven lesions are treated.
$78.06–$82.50
Both involve chemotherapy administration, but 96401 is for subcutaneous or intramuscular delivery; 96405 is for injection directly into lesions.
Compare 96405 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
Northern Nj →
Office / nonfacility
$96.25
Facility
$25.73
Rest Of New Jersey →
Office / nonfacility
$91.38
Facility
$25.00
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96405 billing questions
How many lesions can be reported with 96405?
96405 covers administration into one through seven lesions. For treatment of more than seven lesions, compare the service with 96406 rather than reporting 96405 for every lesion.
How is 96405 different from 11900?
96405 is for intralesional chemotherapy. Code 11900 is for intralesional injection of a substance other than chemotherapy, for up to seven lesions.
Is the chemotherapy drug included in 96405?
No. The code represents administration; report a separately payable drug product under its applicable code when the practice supplies it and documentation supports separate reporting.
Should modifier 50 be used when lesions are on both sides?
No. CMS identifies bilateral adjustment as inappropriate for 96405. Report the service based on the number of treated lesions, not as a bilateral procedure.
What documentation supports 96405?
Record the drug, intralesional route, lesion locations, and number of lesions treated. The count supports choosing 96405 for up to seven lesions or 96406 for more than seven.
How does CMS handle other procedures performed in the same session?
The highest-valued procedure is paid in full, and other procedures in the same session are subject to the standard multiple procedure reduction. CMS does not pay an assistant at surgery for 96405.
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.
12,79496381,,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
12,79996409,,Chemo iv push sngl drug,A,,0.24,2.83,,2.83,NA,0.06,3.13,3.13,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80096411,,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