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See a sample rate comparisonCPT 96409 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.
Injection Of Drug Into Vessel, One Or More Chemotherapy Agents Or Other Complex Drugs Injected Over Several Minutes Into A Blood Vessel.
| 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 | $104.55 national non-facility rate (2026) · View Medicare rates for 96409 |
| Medicaid Fee Schedule | $83.84 median of the 8 states in the free preview · View Medicaid rates for 96409 |
National average reimbursement for CPT 96409 by major payers:
$155.02
$138.79
$146.92
$178.69
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CPT 96409
5 of 25 sample ratesHigher to lower in this preview
Jan Mrani
Aurora Medical Group Inc
$376.51Published rateHealth And Smile Consulting Inc
$109.76Published ratePriti Mehta
Healthcare Md LLC
$99.01Published rateYue Wang
Yue Wang Md LLC
$86.48Published rateZorayda De Leon
Jae Medical Clinic LLC
$29.13Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96409 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 96409 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 96409 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 |
|---|---|---|
| 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) |
| 96413-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. |
| 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 96409. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96409 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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