Billing code 96413: Chemo IV infusionMedicare rate & RVUs in Texas
Report the initial hour of intravenous antineoplastic or qualifying highly complex biologic infusion when the drug runs longer than 15 minutes.
Medicare pays $122.16–$140.07 for 96413 in the office in Texas, from Beaumont to Austin. 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 96413 covers
Code 96413 captures the initial hour of an intravenous antineoplastic infusion or an infusion of another agent that meets chemotherapy administration requirements for high-complexity biologic therapy. Oncology nurses commonly administer these treatments in physician offices or outpatient infusion suites under an oncologist’s or hematologist’s supervision. Paclitaxel or carboplatin infusions are familiar examples. Nursing work includes preparing the infusion, assessing the patient, monitoring for reactions, and ending the infusion; classification as a monoclonal antibody alone does not establish eligibility for chemotherapy administration coding.
Report one initial administration service per encounter unless separate medically necessary IV sites support distinct initial services. Record the drug and actual start and stop times; infusion lasting more than 15 minutes supports 96413, and 96415 begins only when the infusion exceeds 90 minutes. Sequential chemotherapy drugs and separately administered premedications or hydration may support additional administration codes when their requirements are met. The IV start, routine flush, and usual supplies are included; report separately payable drug products with appropriate HCPCS codes. CMS classifies 96413 as an incident-to service, 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 96413 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$122.16 to $140.07
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $140.07 | Unavailable |
| Beaumont | $122.16 | Unavailable |
| Brazoria | $131.74 | Unavailable |
| Dallas | $132.54 | Unavailable |
| Fort Worth | $131.35 | Unavailable |
| Galveston | $132.09 | Unavailable |
| Houston | $133.37 | Unavailable |
| Rest Of Texas | $126.84 | Unavailable |
How the 96413 rate is calculated
Each of 96413’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 · 96413
RVUs × geographic indexes × conversion factor
Work0.28
0.28 RVUs× 1.000 GPCI
Practice expense3.64
3.64 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
3.9900
Conversion factor
$33.4009
Medicare rate
$133.27
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 96413
The CMS indicators that decide how 96413 is paid alongside other services.
CMS payment indicators · 96413
Chemo IV 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. |
96413 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 96409Chemotherapy push
- 96409 describes an antineoplastic IV push, including drug administration lasting 15 minutes or less. Use 96413 for a qualifying infusion lasting more than 15 minutes; document its start and stop times.
- 96365IV drug infusion
- 96365 is the initial IV infusion of a drug that does not meet chemotherapy administration requirements, such as an antibiotic. Use 96413 for an antineoplastic or other agent that qualifies for high-complexity chemotherapy administration.
- 96417Chemotherapy infusion
- 96417 is an add-on for a different chemotherapy drug infused sequentially after the initial drug. Use 96413 for the initial chemotherapy infusion of the encounter.
- 96416Pump infusion
- 96416 describes initiation of a prolonged chemotherapy infusion lasting more than eight hours through a portable or implantable pump. Use 96413 for the initial hour of a directly administered IV infusion.
96413 billing questions
How long must the infusion run to report 96413 instead of a push code?
The infusion must last more than 15 minutes. If the drug runs for 15 minutes or less, report 96409 for an antineoplastic IV push.
When is 96415 added for extra time?
Add 96415 for each additional hour of the same infusion once the infusion exceeds 90 minutes. An infusion lasting exactly 90 minutes supports 96413 alone.
Can 96413 be billed more than once on the same day?
Report one initial administration service per encounter unless separate medically necessary IV sites support distinct initial services. Append modifier 59 or, when accepted, XS to the distinct service and document the separate sites.
How are antiemetic premedications and hydration reported with chemotherapy?
A separately administered antiemetic may support 96375 for an IV push or 96367 for a sequential infusion. Medically necessary hydration may support 96361 when its time is separately documented, exceeds 30 minutes, and is not concurrent with the drug infusion.
Is a same-day E/M visit separately billable with 96413?
Yes, when the clinician performs a significant, separately identifiable evaluation beyond the routine pre-infusion assessment; append modifier 25 to the E/M code. Routine nursing checks and vital signs are part of the administration service.
Does 96413 include the chemotherapy drug itself?
No. Report a separately payable drug with its appropriate HCPCS code, often a J code, using units based on the administered dose and documenting any reportable waste.
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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