$83.35
Both describe intralesional chemotherapy administration. Choose 96406 when more than seven lesions are treated; 96405 is for seven or fewer.
On this page
CMS RVU26D · Effective 2026-10-01
96406 Intralesional chemotherapy Medicare reimbursement rates in Vermont
Reports administration of antineoplastic medication directly into more than seven lesions during treatment of multiple localized lesions. Compare 96406 office and facility rates across CMS payment localities in Vermont.
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 96406 in Vermont?
Vermont has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$129.91
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
Facility setting
$36.33
1 of 1 localities have a supported rate.
Payment area: Vermont
One mapped payment locality.
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 96406: Intralesional chemotherapy, more than seven lesions
Reports administration of antineoplastic medication directly into more than seven lesions during treatment of multiple localized lesions.
This service covers delivery of an antineoplastic medication directly into more than seven discrete lesions. Dermatology and oncology clinicians may perform it in an office or other treatment setting when lesions are treated individually by the intralesional route. The code reflects the number of lesions treated, not the number of injections, syringes, or medications used. It is distinct from systemic chemotherapy delivered by subcutaneous, intramuscular, intravenous, or other routes.
Select the code based on the documented lesion count: this level is for more than seven treated lesions, while 96405 is the lower-count sibling. Record the lesions treated, their sites, the medication, and the intralesional route. The medication is separate from the administration service when separately reportable. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When multiple procedures occur 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; assistant-at-surgery payment is restricted, and co-surgeon and team-surgery billing are not permitted.
CMS billing rules for 96406
- 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 RVU0.80 · 20%
- Practice expense (office) RVU3.09 · 78%
- Malpractice RVU0.06 · 2%
779
Medicare services in 2024 · #3180 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.
96406 compared with similar codes
Office rates for Vermont, from the same CMS release.
$70.52
96401 describes antineoplastic administration by the subcutaneous or intramuscular route. This code is for medication injected directly into more than seven lesions.
$102.61
96409 is for antineoplastic medication given by intravenous push. This code applies to direct intralesional treatment of more than seven lesions.
Compare 96406 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.
1 of 1 payment localities
Vermont →
Office / nonfacility
$129.91
Facility
$36.33
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 96406 in Vermont.
PPRRVU2026_Oct_nonQPP.csv
12,798
- Code
- 96406
- Physician work
- 0.80
- Practice expense
- 3.09
- Malpractice
- 0.06
GPCI2026.csv
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.80 | × 1.000 | 0.8000 |
| Practice expense | 3.09 | × 0.990 | 3.0591 |
| Malpractice | 0.06 | × 0.506 | 0.0304 |
| Total RVUs | 3.8895 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Vermont$129.91
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.8 | 1 |
| Practice expense | 3.09 | 0.99 |
| Malpractice | 0.06 | 0.506 |
(0.8 × 1 + 3.09 × 0.99 + 0.06 × 0.506) × $33.4009 = $129.91
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.8 | 1 |
| Practice expense | 0.26 | 0.99 |
| Malpractice | 0.06 | 0.506 |
(0.8 × 1 + 0.26 × 0.99 + 0.06 × 0.506) × $33.4009 = $36.33
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
96406 billing questions
How is this code distinguished from 96405?
Use this code when more than seven lesions are treated intralesionally. Use 96405 for seven or fewer treated lesions.
Are units based on injections or lesions?
The threshold is based on the number of lesions treated, not the number of needle entries or syringes. Document the treated lesion count and sites.
Is the antineoplastic medication included?
This code reports the administration service, not the medication itself. Report the drug separately when it is separately reportable.
Can modifier 50 be used for lesions on both sides?
No. CMS identifies modifier 50 as inappropriate for this service; treatment of lesions on both sides does not make it a bilateral procedure.
How does the same-session multiple-procedure rule affect payment?
When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and the others are subject to the standard 50% reduction.
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.
12,79596401,,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
12,80196413,,Chemo iv infusion 1 hr,A,,0.28,3.64,,3.64,NA,0.07,3.99,3.99,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
10204412,TX,18,HOUSTON,1.008,0.993,1.376
10304412,TX,99,REST OF TEXAS,1.000,0.949,0.903
10403502,UT,09,UTAH,1.000,0.940,0.898
10514512,VT,50,VERMONT,1.000,0.990,0.506
10611302,VA,00,VIRGINIA,1.000,0.983,0.706
10709202,VI,50,VIRGIN ISLANDS,1.000,1.011,0.985
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817