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See a sample rate comparisonCPT 96542 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.
Chemotherapy Injection Subara, Chemotherapy Injection Subarachnoid Or Intraventricular Viasubcutaneous Reservoir Single Or Multiple Agents
| 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 | 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service Q1 - Routine clinical service provided in a clinical research study |
| Complexity Level | Low |
| Medicare Fee Schedule | $134.27 national non-facility rate (2026) · View Medicare rates for 96542 |
| Medicaid Fee Schedule | $108.285 median of the 8 states in the free preview · View Medicaid rates for 96542 |
National average reimbursement for CPT 96542 by major payers:
$181.99
$174.07
$173.69
$90.91
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CPT 96542
5 of 25 sample ratesHigher to lower in this preview
Prisma Health-Upstate
Prisma Health - Upstate
$1,513.95Published ratePrisma Health-Upstate, Prisma Health Center For Pediatric Med
Prisma Health - Upstate
$1,513.95Published rateKara Driscoll
UPMC
$263.55Published rateChristus Health Ark-La-Tex, Christus St. Michael Health System
Christus Trinity Clinic
$150.63Published rateJulie Webster
Musc Community Physicians
$45.43Published rate
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See a sample payer proposalCPT 96542 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 96542 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 96542 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 |
|---|---|---|
| 96450-CPT | Moderate | Chemotherapy Administration I, Chemotherapy Administration Into Cns (Eg Intrathecal)Requiring And Including Lumbar Puncture Chemotherapy Administration Into Cns (Eg Intrathecal) |
| 96521-CPT | Low | Infusion Pump Maintenance, Refill And Maintenance Of Either A Portable Or An Implanted Pump Used For Delivering Chemotherapy. |
| 96522-CPT | Low | Refilling And Maintenance Of I, Refilling And Maintenance Of Implantable Pump Or Reservoir For Drug Delivery Systemic (Eg Intravenous Intra-Arterial) |
| 96542-CPT | Low | Chemotherapy Injection Subara, Chemotherapy Injection Subarachnoid Or Intraventricular Viasubcutaneous Reservoir Single Or Multiple Agents |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 96542. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 96542 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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