Billing code 96402: Hormonal therapy injectionMedicare rate & RVUs in Oregon
Report this service when a hormonal antineoplastic drug is administered by subcutaneous or intramuscular injection, such as in oncology treatment.
Medicare pays $38.42–$42.20 for 96402 in the office in Oregon, from Rest Of Oregon to Portland. 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 96402 covers
This service covers administration of a hormonal antineoplastic agent by subcutaneous or intramuscular injection. It is commonly performed in an oncology or urology practice for cancer treatment, including administration of agents such as leuprolide, goserelin, or fulvestrant when used as hormonal antineoplastic therapy. The code represents the administration service, not the drug itself.
Select this code based on the agent’s hormonal antineoplastic role and the injection route; a nonhormonal antineoplastic injection uses a different administration code. Record the medication, indication, route, and administration in the clinical documentation. The drug may be reported separately when the practice supplies it and applicable drug-coding requirements are met. Under the CMS rule for this service, it is billed as an incident-to service only when performed under physician supervision.
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 96402 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $42.20 | Unavailable |
| Rest Of Oregon | $38.42 | Unavailable |
How the 96402 rate is calculated
Each of 96402’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 · 96402
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.19Practice expense 0.95Malpractice 0.02
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96402
The CMS indicators that decide how 96402 is paid alongside other services.
CMS payment indicators · 96402
Hormonal therapy injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| 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. |
96402 compared with similar codes
Compare codes
96402 vs 96401 vs 96372 vs 96409: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 96401Chemotherapy injection
- Both codes cover subcutaneous or intramuscular antineoplastic administration. Choose 96402 for a hormonal antineoplastic agent and 96401 for a nonhormonal agent.
- 96372SC/IM injection
- Use 96372 for a qualifying therapeutic, prophylactic, or diagnostic injection that is not an antineoplastic administration. Use 96402 for a hormonal antineoplastic agent.
- 96409Chemotherapy push
- Code 96409 describes antineoplastic administration by intravenous push. Code 96402 applies when the hormonal antineoplastic agent is given subcutaneously or intramuscularly.
96402 billing questions
How does this differ from 96401?
Use 96402 for a hormonal antineoplastic agent given subcutaneously or intramuscularly. Code 96401 is for a nonhormonal antineoplastic agent by those routes.
Can the drug be billed separately?
The administration code covers the injection service, not the medication. When the practice supplies the drug, report the appropriate drug code separately if applicable.
Can this be billed for any subcutaneous or intramuscular injection?
No. The agent must be a hormonal antineoplastic drug. A routine therapeutic injection, such as a non-antineoplastic medication, is not reported with this code.
What documentation supports reporting 96402?
Document the hormonal antineoplastic agent, its cancer-treatment indication, the subcutaneous or intramuscular route, and that the injection was administered.
What supervision is required for Medicare billing?
CMS specifies that this incident-to service is 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 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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