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See a sample rate comparisonCPT 96413 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.
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.
| 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 PN - Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital |
| Complexity Level | Low |
| Medicare Fee Schedule | $133.27 national non-facility rate (2026) · View Medicare rates for 96413 |
| Medicaid Fee Schedule | $109.03 median of the 8 states in the free preview · View Medicaid rates for 96413 |
National average reimbursement for CPT 96413 by major payers:
$197.16
$181.31
$193.74
$226.93
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CPT 96413
5 of 25 sample ratesHigher to lower in this preview
Saima Khan
Hunterdon Specialty Care PC
$377.64Published ratePriya Simoes
$290.72Published rateJonathan Potack
Westchester Medical Center Advanced Physician Services, P.C
$211.03Published rateGautam Gupta
Capital Health Multispecialty Group
$151.75Published rateHimanshu Patel
Kishanhenal Limited Liability Company
$76.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96413 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 96413 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 96413 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 96413. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96413 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 can start by asking your healthcare provider for an estimate. However, for more precise and location-specific pricing information, especially when looking up costs based on CPT codes, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get detailed pricing data.
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services and procedures. They are crucial for pricing because they provide a universal language for billing and reimbursement, allowing insurance companies and patients to understand exactly what services were performed and to determine the associated costs and coverage.
Fee schedules for medical services can vary significantly based on location, provider, and insurance plan. While some general information might be available, to get specific fee schedule data tailored to a CPT code and your location, you can use specialized tools. Payerprice, for instance, provides a fee schedule lookup tool that allows users to search with a CPT code and a specific location to find relevant pricing information.
Insurance companies determine what they pay based on several factors, including their contracted rates with providers, the specific terms of your health insurance plan (deductibles, copayments, coinsurance), medical necessity criteria, and the CPT codes submitted for services. They negotiate rates with providers, and these negotiated rates often form the basis of their fee schedules. The allowed amount for a service is typically the maximum an insurer will pay.
Your provider's charge (also known as the billed amount or sticker price) is the amount the healthcare provider initially asks for a service. What your insurance pays is often a negotiated rate, which is typically lower than the provider's charge. This negotiated rate is called the "allowed amount." After your insurance pays its portion of the allowed amount, you are responsible for the remaining balance, which may include your deductible, copayment, or coinsurance, up to your out-of-pocket maximum. The difference between the billed amount and the allowed amount is often a contractual write-off by the provider.