2025 CPT code 96409
Chemotherapy administration; intravenous push technique, single or initial substance/drug.
Modifiers may apply depending on the circumstances of the service.Consult the CPT manual and payer-specific guidelines for details.
The medical necessity for 96409 is established by the patient's diagnosis of cancer or a condition requiring antineoplastic therapy.Documentation must demonstrate the need for chemotherapy based on established clinical guidelines and standards of care.
The physician or other qualified healthcare professional is responsible for ordering the chemotherapy, determining the dosage, and overseeing the administration of the medication.Direct supervision may be required depending on the patient's condition and the complexity of the drug regimen.
- Medicine Services and Procedures > Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration
- Chemotherapy services are primary to therapeutic, prophylactic, and diagnostic services, which are primary to hydration services. Infusions are primary to pushes, which are primary to injections.
In simple words: This code covers giving a single dose of chemotherapy directly into a vein.The doctor or nurse carefully injects the medicine, watching the patient closely for any problems. This is usually a quick injection or a very short infusion.
This CPT code reports the intravenous administration of a single or initial chemotherapeutic agent via a push technique.The push technique involves direct injection of the drug into the IV access, typically requiring the provider's continuous presence for administration and patient observation, or an infusion lasting 15 minutes or less.This code encompasses the administration of non-radionuclide antineoplastic drugs, agents used for non-cancer diagnoses (e.g., cyclophosphamide for autoimmune conditions), monoclonal antibody agents, and other biologic response modifiers.Preparation of the chemotherapy agent is included and should not be reported separately.
Example 1: A patient with advanced lung cancer receives an initial dose of cisplatin intravenously via a rapid push., A patient with breast cancer is given a single IV push of docetaxel as part of a multi-drug chemotherapy regimen. , A patient undergoing treatment for lymphoma receives a short infusion (10 minutes) of rituximab intravenously, administered as an initial dose.
* Complete patient demographics* Diagnosis codes (ICD-10) supporting medical necessity* Drug administered (name, dosage, route)* Start and stop times of the administration* Provider's signature* Documentation of any adverse reactions or complications
** When multiple drugs are administered on the same date, only one initial service code (96409) should be reported unless two separate IV sites are required.Subsequent or concurrent administrations should be reported using appropriate add-on codes (96411, etc.).Hydration is considered incidental and not separately billable.
- Revenue Code: P7B (ONCOLOGY - OTHER)
- RVU: The relative value units (RVUs) for this code vary depending on geographic location, facility type, and payer.Consult the appropriate fee schedule for specific reimbursement information.The provided example indicated an approximate payment of $102.00 but this is not guaranteed.
- Global Days: Not applicable.This is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code.
- Fee Schedule: Historical fee schedules are not provided in the source information, but they vary widely depending on location, payer, and year.Access historical data through a relevant medical billing database.
- Specialties:Oncology, Hematology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center, Inpatient Hospital (depending on clinical context)