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See a sample rate comparisonCPT 96406 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.
Drug Injected Into Skin Lesion, An Injection Of A Chemotherapy Drug Directly Into A Skin Lesion Usually A Cancerous Lesion.
| 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 | PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $131.93 national non-facility rate (2026) · View Medicare rates for 96406 |
| Medicaid Fee Schedule | $104.305 median of the 8 states in the free preview · View Medicaid rates for 96406 |
National average reimbursement for CPT 96406 by major payers:
$177.72
$159.45
$164.92
$87.19
Compare published rates across providers.
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CPT 96406
5 of 25 sample ratesHigher to lower in this preview
Bluesky Telepsych
$296.38Published rateMelvin Joseph
Advocate Health And Hospitals Corporation
$217.72Published rateJohn Millichap
Community Care Network Inc
$182.72Published rateClint Anthony
$141.39Published rateLauren Prest
$59.36Published rate
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See a sample payer proposalCPT 96406 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 96406 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 96406 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 |
|---|---|---|
| 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. |
| 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. |
| 96411-CPT | Low | Chemotherapy Administration I, Chemotherapy Administration Intravenous Push Technique Each Additional Substancedrug (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96406 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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