Billing code 96415: Chemo infusion add-onMedicare rate & RVUs in Ohio
Report 96415 when an intravenous chemotherapy or highly complex drug infusion continues long enough beyond its initial or sequential hour to qualify for additional-hour billing.
Medicare pays $26.54 for 96415 in the office in Ohio (Ohio). 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 96415 covers
This code captures continued infusion time when an intravenous chemotherapy, biologic response modifier, monoclonal antibody, or other highly complex drug infusion runs past its initial hour. Oncology and infusion nurses typically hang and monitor the infusion in physician offices and infusion suites, watching for hypersensitivity reactions, extravasation, and vital sign changes. Multi-hour monoclonal antibody infusions and slow-titrated first doses are common reasons for additional infusion time.
Report one unit for each qualifying additional hour after the initial hour reported with 96413 or a sequential hour reported with 96417. The first additional unit requires more than 30 minutes beyond that hour; for a single continuous infusion, total time must exceed 90 minutes. Record start and stop times for each infusion, the drug, route, and clinical monitoring. As an add-on, 96415 is billed with an eligible primary chemotherapy infusion service, normally 96413, and paid within that procedure’s global period. This incident-to service is billed only when performed under physician supervision. Report the drug separately with the appropriate HCPCS drug code and units when separately billable.
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.
96415 in Ohio
| Payment locality | Office | Facility |
|---|---|---|
| Ohio | $26.54 | Unavailable |
How the 96415 rate is calculated
Each of 96415’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 · 96415
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.19Practice expense 0.64Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96415
The CMS indicators that decide how 96415 is paid alongside other services.
CMS payment indicators · 96415
Chemo infusion add-on
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
96415 compared with similar codes
Compare codes
96415 vs 96413 vs 96417 vs 96366 vs 96416: national Medicare rates
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How to choose
- 96413Chemo IV infusion
- 96413 covers the initial chemotherapy infusion, up to one hour, and is reported once; 96415 counts qualifying additional hours and cannot stand alone.
- 96417Chemotherapy infusion
- 96417 covers an additional sequential infusion of a different drug, up to one hour; qualifying continued hours of that infusion use 96415.
- 96366IV infusion add-on hour
- 96366 covers qualifying additional hours of standard therapeutic, prophylactic, or diagnostic infusions, such as antibiotics; 96415 covers chemotherapy and other highly complex agents.
- 96416Pump infusion
- 96416 reports initiation of a pump-driven infusion lasting over eight hours, often continued away from the office; 96415 counts qualifying additional hours of a monitored infusion.
96415 billing questions
When does the first unit of 96415 become reportable?
A unit requires more than 30 minutes beyond the first hour. For a single-drug infusion, total time must exceed 90 minutes; an infusion of 90 minutes or less is reported with 96413 alone.
Can 96415 be used with a sequential chemotherapy infusion?
Yes. Report 96417 for an additional sequential infusion of a different drug, up to one hour, and 96415 for each qualifying additional hour of that infusion.
How many units are billed for a four-hour infusion of one drug?
Report 96413 for the initial hour and three units of 96415 for the remaining three hours.
Should non-chemotherapy drugs infused past the first hour use 96415?
Standard therapeutic, prophylactic, or diagnostic infusions use 96366 for qualifying additional hours. Code 96415 covers chemotherapy and other highly complex agents.
Is the drug itself included in 96415?
The code covers administration time. When separately billable, report the drug with its appropriate HCPCS code and units.
What documentation supports the additional hours?
Record start and stop times for each infusion, the agent, route, and nursing monitoring. Without stop times, additional-hour units cannot be supported.
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
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