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See a sample rate comparisonCPT 96416 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.
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
| 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 19 - Off Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $133.27 national non-facility rate (2026) · View Medicare rates for 96416 |
| Medicaid Fee Schedule | $108.125 median of the 8 states in the free preview · View Medicaid rates for 96416 |
National average reimbursement for CPT 96416 by major payers:
$202.77
$186.02
$194.69
$231.76
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CPT 96416
5 of 25 sample ratesHigher to lower in this preview
Monica Fornier
Memorial Developmental Chemo Group
$718.32Published rateLixin Liao
Us Oncology Corporate, Inc.
$327.60Published rateAndrew Ip
Regional Cancer Care Associates LLC
$235.78Published rateMichael Rachshtut
Redeemer Cancer Care Physicians Network LLC
$192.58Published rateOncology Care Partners Of Florida LLC, Oncology Care Partners
Oncology Care Partners Of Florida LLC
$125.02Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96416 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 96416 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 96416 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. |
| 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. |
| 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 96416. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96416 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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