$130.52–$155.68
96413 covers the initial chemotherapy infusion, up to one hour, and is reported once; 96415 counts qualifying additional hours and cannot stand alone.
On this page
CMS RVU26D · Effective 2026-10-01
96415 Chemo infusion add-on Medicare reimbursement rates in Virginia
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. Compare 96415 office and facility rates across CMS payment localities in Virginia.
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 96415 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$27.83–$32.61
2 of 2 localities have a supported rate.
Facility setting
No supported rate
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 96415: Chemotherapy IV infusion, each additional hour
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.
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.
CMS billing rules for 96415
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.19 · 22%
- Practice expense (office) RVU0.64 · 75%
- Malpractice RVU0.02 · 2%
643.7K
Medicare services in 2024 · #195 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.
96415 compared with similar codes
Office rates for Virginia, from the same CMS release.
$65.18–$77.36
96417 covers an additional sequential infusion of a different drug, up to one hour; qualifying continued hours of that infusion use 96415.
$21.02–$24.41
96366 covers qualifying additional hours of standard therapeutic, prophylactic, or diagnostic infusions, such as antibiotics; 96415 covers chemotherapy and other highly complex agents.
$130.48–$155.97
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.
Compare 96415 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
$32.61
Facility
Unavailable
Virginia →
Office / nonfacility
$27.83
Facility
Unavailable
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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 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.
12,79996409,,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
12,80296415,,Chemo iv infusion addl hr,A,,0.19,0.64,,0.64,NA,0.02,0.85,0.85,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80396416,,Chemo prolong infuse w/pump,A,,0.21,3.71,,3.71,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
12,80496417,,Chemo iv infus each addl seq,A,,0.21,1.75,,1.75,NA,0.03,1.99,1.99,5,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,80596420,,Chemo ia push tecnique,A,,0.17,2.92,,2.92,NA,0.06,3.15,3.15,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00