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See a sample rate comparisonCPT 96425 Fee Schedule
Last Verified: September 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.
Chemotherapy Infusion Method, Chemotherapy Administration Intra Arterial Infusion Technique Initiation Of Prolonged Infusion More Than 8 Hours Requiring The 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 22 - On Campus Outpatient Hospital |
| Common Modifiers | None 59 - Distinct Procedural Service PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 96425 |
| Medicaid Fee Schedule | View Medicaid rates for 96425 |
National average reimbursement for CPT 96425 by major payers:
$255.63
$223.25
$235.32
$274.37
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CPT 96425
5 of 25 sample ratesHigher to lower in this preview
Sunila Oconnor
Pediatric Faculty Foundation In
$445.95Published rateAbby Fredrickson
$354.95Published rateKevin Varghese
Riverside Health System
$302.39Published ratePhilip Janicak
Edward Health Ventures
$257.48Published rateDa Pediatric Rehabilitation
$60.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 96425 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 96425 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 96425 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 |
|---|---|---|
| 96420-CPT | Low | Chemotherapy Administration I, Chemotherapy Administration Intra-Arterial Push Technique Chemotherapy Administration Intra-Arterial Push Technique |
| 96422-CPT | Moderate | Drug Infused Into An Artery, Infusion Of A Chemotherapy Agent Or Other Complex Drug Into An Artery. An Infusion Delivers Fluid And/Or Medication Slowly Over A Period Time. |
| 96423-CPT | Low | Chemo Ia Infuse Each Addl Hr, Chemotherapy Administration Intra Arterial Infusion Technique Each Additional Hour List Separately In Addition To Code For Primary Procedure |
| 96425-CPT | Moderate | Chemotherapy Infusion Method, Chemotherapy Administration Intra Arterial Infusion Technique Initiation Of Prolonged Infusion More Than 8 Hours Requiring The 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 96425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96425 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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