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See a sample rate comparisonCPT 96402 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; Hormonal A, Chemotherapy Administration Subcutaneous Or Intramuscular; Hormonal A
| 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 | $38.75 national non-facility rate (2026) · View Medicare rates for 96402 |
| Medicaid Fee Schedule | $30.54 median of the 8 states in the free preview · View Medicaid rates for 96402 |
National average reimbursement for CPT 96402 by major payers:
$52.54
$43.23
$47.49
$63.60
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CPT 96402
5 of 25 sample ratesHigher to lower in this preview
Percy Genyk
Hunterdon Medical Center
$83.79Published rateTamara Fisicaro
Advocare, LLC
$45.72Published rateSangeeta Buddala
Advocare, LLC
$45.72Published rateDeborah Cheung
$39.95Published rateMaya Ramchand
Smithville Medical Associates LLC
$30.09Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96402 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 96402 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 96402 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 |
| 96409-CPT | Low | Injection Of Drug Into Vessel, One Or More Chemotherapy Agents Or Other Complex Drugs Injected Over Several Minutes Into A Blood Vessel. |
| 96415-CPT | Low | Infusion Of Chemotherapy, Infusion Of A Chemotherapy Agent Or Other Complex Drug Into A Vein. An Infusion Delivers A Fluid And/Or Medication Slowly Over A Period Of Time. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96402 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
To find out the cost of a medical procedure, you generally need the specific Current Procedural Terminology (CPT) code for the service, which you can get from your doctor or healthcare provider. Once you have the CPT code, for specific pricing based on your CPT code and location, Payerprice offers a fee schedule lookup tool that can be very helpful.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services. These codes are crucial for billing and for determining the cost of a specific service. Knowing the CPT code allows you to look up more accurate pricing information, as different services have different codes and associated costs.
You can look up the price of a specific medical service by first obtaining the CPT code from your healthcare provider. For precise pricing information based on specific CPT codes and your location, you can use specialized tools like Payerprice's fee schedule lookup tool. This tool allows users to search with CPT codes and specific locations.
Yes, healthcare prices can vary significantly by location, even within the same state or city. Factors such as regional cost of living, facility fees, and varying negotiation power between providers and insurers contribute to these differences. When researching costs, it's crucial to consider tools that allow you to search for prices based on your specific location, such as Payerprice.
It can be challenging to get a straightforward answer on healthcare costs due to complex insurance contracts, varying pricing structures between providers, facility fees, and a general lack of price transparency. Your out-of-pocket cost will also depend on your specific insurance plan. However, tools like Payerprice are designed to help by providing access to fee schedules for specific CPT codes and locations, offering greater transparency.
Yes, there are tools available to help you compare healthcare prices. To get the most accurate comparison, you'll need the specific CPT code for the service you're looking for. For users seeking to find fee schedules based on CPT codes and their specific location, Payerprice offers a valuable fee schedule lookup tool. This can help you understand potential costs before a procedure.