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See a sample rate comparisonCPT 96401 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Chemothera Administr Subcutane Or Intramuscul; Non-Hormon, Chemotherapy Administration Subcutaneous Or Intramuscular; Non-Hormon
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
| Medicare Fee Schedule | $71.81 national non-facility rate (2026) · View Medicare rates for 96401 |
| Medicaid Fee Schedule | $56.44 median of the 8 states in the free preview · View Medicaid rates for 96401 |
National average reimbursement for CPT 96401 by major payers:
$102.12
$91.91
$100.39
$123.09
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CPT 96401
5 of 25 sample ratesHigher to lower in this preview
Jeremy Katcher
Washington University
$278.17Published rateJinlin Du
Crystal Run Healthcare Physicians, LLP
$154.55Published rateMarguerite Lengkeek
Allergy & Asthma Specialists, Ltd.
$91.20Published rateTracy Bridges
The Allergy Center At Brookstone, P.C.
$68.09Published rateLizette Hernandez
$57.75Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96401 vs. Other Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Codes
The CPT 96401 code is part of the Medicine Services and Procedures services used for Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 96401 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 96401-CPT | Low | Chemothera Administr Subcutane Or Intramuscul; Non-Hormon, Chemotherapy Administration Subcutaneous Or Intramuscular; Non-Hormon |
| 96402-CPT | Low | Chemothera Administr Subcutane Or Intramuscul; Hormonal A, Chemotherapy Administration Subcutaneous Or Intramuscular; Hormonal A |
| 96405-CPT | Low | Chemothera Administr; Intralesional Up To & Inclu 7 Lesi, Chemotherapy Administration; Intralesional Up To And Including 7 Lesi |
| 96406-CPT | Low | Drug Injected Into Skin Lesion, An Injection Of A Chemotherapy Drug Directly Into A Skin Lesion Usually A Cancerous Lesion. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96401. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96401 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians and other healthcare providers to report medical, surgical, and diagnostic procedures and services to entities such as physicians, insurance companies, and accreditation organizations. They are essential for accurate billing and reimbursement.
To find the cost of a specific medical procedure based on a CPT code and your specific location, you can use tools designed for this purpose. Payerprice offers a fee schedule lookup tool where you can search using a CPT code and location to get an estimate. This can help you understand potential costs before receiving care.
CPT (Current Procedural Terminology) codes describe the medical services or procedures performed by a healthcare provider (e.g., an office visit, surgery, lab test). ICD-10 (International Classification of Diseases, 10th Revision) codes, on the other hand, describe the diagnosis or reason for the patient's visit or treatment (e.g., a specific illness, injury, or symptom). Both are necessary for complete medical billing, with CPT codes explaining 'what was done' and ICD-10 codes explaining 'why it was done'.
Medical billing can be complicated due to several factors, including the vast number of CPT and ICD-10 codes, various insurance plans with different coverage rules and deductibles, government regulations, and the need for accurate documentation to ensure proper reimbursement. The complexity also arises from the interplay between providers, patients, and multiple payers, each with their own processes and requirements.
A fee schedule is a comprehensive list of fees used by healthcare providers and insurance companies to define the maximum amount that will be paid for specific medical services or procedures. It outlines the allowable charges for each CPT code and other healthcare services. These schedules are crucial for determining reimbursement rates and for patients to understand the potential costs associated with their care.