$68.22
Both codes cover subcutaneous or intramuscular antineoplastic administration. Choose 96402 for a hormonal antineoplastic agent and 96401 for a nonhormonal agent.
On this page
CMS RVU26D · Effective 2026-10-01
96402 Hormonal therapy injection Medicare reimbursement rates in Wisconsin
Report this service when a hormonal antineoplastic drug is administered by subcutaneous or intramuscular injection, such as in oncology treatment. Compare 96402 office and facility rates across CMS payment localities in Wisconsin.
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 96402 in Wisconsin?
Wisconsin 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
$36.95
1 of 1 localities have a supported rate.
Payment area: Wisconsin
One mapped payment locality.
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 96402: Hormonal antineoplastic injection administration
Report this service when a hormonal antineoplastic drug is administered by subcutaneous or intramuscular injection, such as in oncology treatment.
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.
CMS billing rules for 96402
- Professional and technical components
- Incident-to service: billed only when performed under physician supervision.
Where the value comes from
- Work RVU0.19 · 16%
- Practice expense (office) RVU0.95 · 82%
- Malpractice RVU0.02 · 2%
335.4K
Medicare services in 2024 · #290 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.
96402 compared with similar codes
Office rates for Wisconsin, from the same CMS release.
$14.74
Use 96372 for a qualifying therapeutic, prophylactic, or diagnostic injection that is not an antineoplastic administration. Use 96402 for a hormonal antineoplastic agent.
$99.19
Code 96409 describes antineoplastic administration by intravenous push. Code 96402 applies when the hormonal antineoplastic agent is given subcutaneously or intramuscularly.
Compare 96402 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
Wisconsin →
Office / nonfacility
$36.95
Facility
Unavailable
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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 96402 in Wisconsin.
PPRRVU2026_Oct_nonQPP.csv
12,796
- Code
- 96402
- Physician work
- 0.19
- Practice expense
- 0.95
- Malpractice
- 0.02
GPCI2026.csv
111
- Locality
- Wisconsin
- Physician work
- 1.000
- Practice expense
- 0.958
- Malpractice
- 0.308
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.19 | × 1.000 | 0.1900 |
| Practice expense | 0.95 | × 0.958 | 0.9101 |
| Malpractice | 0.02 | × 0.308 | 0.0062 |
| Total RVUs | 1.1063 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Wisconsin$36.95
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.19 | 1 |
| Practice expense | 0.95 | 0.958 |
| Malpractice | 0.02 | 0.308 |
(0.19 × 1 + 0.95 × 0.958 + 0.02 × 0.308) × $33.4009 = $36.95
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.
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 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.
12,79396380,,Admn rsv monoc antb im cnsl,A,,0.28,0.60,,0.60,NA,0.02,0.90,0.90,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79496381,,Admn rsv monoc antb im njx,A,,0.17,0.55,,0.55,NA,0.01,0.73,0.73,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79596401,,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
10802402,WA,02,SEATTLE (KING CNTY),1.050,1.227,0.817
10902402,WA,99,REST OF WASHINGTON,1.013,1.053,0.761
11011402,WV,16,WEST VIRGINIA,1.000,0.869,1.431
11106302,WI,00,WISCONSIN,1.000,0.958,0.308
11203602,WY,21,WYOMING**,1.000,1.000,0.740
113"MAC Assignments as of November 22, 2023",,,,,,
114,,,,,,