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See a sample rate comparisonCPT 96415 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 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $28.39 national non-facility rate (2026) · View Medicare rates for 96415 |
| Medicaid Fee Schedule | $23.365 median of the 8 states in the free preview · View Medicaid rates for 96415 |
National average reimbursement for CPT 96415 by major payers:
$44.58
$39.57
$42.33
$55.83
Compare published rates across providers.
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CPT 96415
5 of 25 sample ratesHigher to lower in this preview
Maria Ramdial
Medemerge, LLC
$47.59Published rateLingping Gu
Radiology Of Nj, LLC D/B/A Medical Group Of Nj
$35.34Published rateLawrence A Armenti Md PC
$30.04Published rateLouis Friedman
Woodbridge Medical Associates, P.A.
$28.65Published rateNicholas Rossos
$23.71Published rate
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See a sample payer proposalCPT 96415 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 96415 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 96415 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 96415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96415 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 the estimated cost of a medical procedure or service, you typically need to know the specific Current Procedural Terminology (CPT) code. With this code and your location, you can use tools like Payerprice, which offers a fee schedule lookup tool to search with CPT codes and specific locations. It's also advisable to contact your insurance provider directly for a personalized estimate of your out-of-pocket costs, considering your specific plan benefits, deductible, and copayments.
CPT (Current Procedural Terminology) codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding healthcare costs because they provide a universal language for billing and processing insurance claims. Knowing the specific CPT code for a procedure allows you to research its typical cost and understand what your insurance will cover, as well as to use tools like Payerprice for fee schedule lookups.
Many insurance companies are required to provide price transparency tools on their websites, allowing members to estimate costs for services. Additionally, third-party platforms like Payerprice offer fee schedule lookup tools where you can search for CPT codes and specific locations to see typical negotiated rates and costs. It's always a good idea to also contact your insurance provider directly for the most accurate information related to your specific plan's benefits.
If you receive a medical bill that seems too high or unexpected, first review it carefully for any errors and compare it to any Explanation of Benefits (EOB) you received from your insurance company. Contact your healthcare provider's billing department to request an itemized bill and discuss the charges. You can also contact your insurance company to understand their coverage and any discrepancies. For price comparisons, tools like Payerprice can help you understand typical costs for the services you received based on their CPT codes, providing valuable information for your discussions.
To determine your out-of-pocket costs, you need to consider several factors, including your insurance plan's deductible, copayments, coinsurance, and whether the provider is in-network. You can typically get an estimate by contacting your insurance provider directly and providing them with the CPT code for the service. You can also use tools like Payerprice to research typical fee schedules for specific CPT codes and locations, which can help you understand the potential total cost before insurance is applied, aiding in estimating your out-of-pocket expenses.