Billing code 96416: Pump infusionMedicare rate & RVUs in Oregon
Reports initiation of intravenous chemotherapy delivered for more than eight hours through a portable or implantable pump.
Medicare pays $132.08–$146.54 for 96416 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 96416 covers
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.
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 96416 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $146.54 | Unavailable |
| Rest Of Oregon | $132.08 | Unavailable |
How the 96416 rate is calculated
Each of 96416’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 · 96416
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.21Practice expense 3.71Malpractice 0.07
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 96416
The CMS indicators that decide how 96416 is paid alongside other services.
CMS payment indicators · 96416
Pump infusion
| 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. |
96416 compared with similar codes
Compare codes
96416 vs 96413 vs 96415 vs 96417 vs 96425: national Medicare rates
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How to choose
- 96413Chemo IV infusion
- 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.
- 96415Chemo infusion add-on
- Code 96415 represents an additional infusion hour. Code 96416 reports initiation of a prolonged pump-based infusion, rather than successive hourly increments.
- 96417Chemotherapy infusion
- Code 96417 describes a distinct sequential infusion of another chemotherapy drug. It does not represent initiation of the prolonged pump infusion itself.
- 96425Chemotherapy infusion
- Both codes describe prolonged pump-based chemotherapy infusion, but 96425 is for the intra-arterial route; 96416 is for intravenous administration.
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 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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