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See a sample rate comparisonCPT 96405 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; Intralesional Up To & Inclu 7 Lesi, Chemotherapy Administration; Intralesional Up To And Including 7 Lesi
| 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 79 - Unrelated procedure - postop period |
| Complexity Level | Low |
| Medicare Fee Schedule | $84.50 national non-facility rate (2026) · View Medicare rates for 96405 |
| Medicaid Fee Schedule | $68.28 median of the 8 states in the free preview · View Medicaid rates for 96405 |
National average reimbursement for CPT 96405 by major payers:
$124.33
$111.32
$115.23
$58.63
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CPT 96405
5 of 25 sample ratesHigher to lower in this preview
Sana Tabbara
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$127.55Published rateSepideh Mehravaran
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$127.55Published rateAnn Mercier
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$125.05Published rateJon Boettger
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$108.41Published rateChristopher Sanchez
H Lee Moffitt Cancer Ctr & Res Inst Life Time Cancer Scrn Ctr Inc
$106.29Published rate
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See a sample payer proposalCPT 96405 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 96405 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 96405 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 |
| 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. |
| 96416-CPT | Moderate | Chemo Prolong Infuse W Pump, Chemotherapy Administration Intravenous Infusion Technique Initiation Of Prolonged Chemotherapy Infusion More Than 8 Hours Requiring Use Of A Portable Or Implantable Pump |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96405. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96405 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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