2025 CPT code 96413
(Active) Effective Date: N/A Revision Date: N/A Injection and Infusion - Chemotherapy administration Medicine Services and Procedures > Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration Feed
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug.
Modifiers may be applicable in specific circumstances. For example, modifier 59 (distinct procedural service) might be used if additional services are performed on the same day that are distinct from the chemotherapy administration. Consult the AMA CPT® manual for guidance on appropriate modifier use.
Medical necessity for 96413 is established by a physician's order based on the patient's diagnosis and treatment plan.Supporting documentation should demonstrate the need for intravenous chemotherapy administration.
The physician or other qualified healthcare professional is responsible for overseeing the entire chemotherapy administration process, including patient assessment, consent, safety oversight, and direct or indirect supervision of staff administering the infusion.This includes determining the appropriate chemotherapy regimen, monitoring the patient's response to treatment, managing potential adverse effects, and providing discharge instructions.
- 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 chemotherapy drugs through an IV for up to an hour. It's for the first drug given during a visit. If other fluids (hydration) or medicines are given through the same IV line, those will be billed separately. The infusion can take between 16 and 90 minutes.
This CPT code reports the intravenous infusion of chemotherapy drugs or other highly complex biologic agents for up to one hour.It applies to a single or initial substance/drug administered during the encounter. The code is applicable for infusions lasting between 16 and 90 minutes.Hydration, if administered as a secondary or subsequent service via the same IV access, should be reported using code 96361.If therapeutic, prophylactic, or diagnostic drug infusion/injection is administered as a secondary or subsequent service via the same IV access, report codes 96366, 96367, or 96375 as appropriate.
Example 1: A patient with metastatic breast cancer receives their first cycle of docetaxel chemotherapy. The infusion takes 45 minutes. Code 96413 is reported., A patient receiving carboplatin and paclitaxel chemotherapy experiences an allergic reaction. The physician intervenes and manages the reaction, continuing with the infusion. The infusion lasts 70 minutes. Code 96413 is reported.Separate codes would be used to report management of the reaction., A patient with lymphoma undergoes their first treatment with rituximab. The infusion takes 90 minutes and requires additional monitoring due to the unique properties of rituximab. Code 96413 is reported.
Detailed documentation should include the diagnosis, type and amount of chemotherapy agent administered, infusion time, route of administration, any adverse reactions and their management, and physician's orders.Patient consent forms and any relevant laboratory results should also be documented.
** Always refer to the most current CPT® and payer-specific guidelines for the most up-to-date coding and billing practices.This information is for general guidance only and should not substitute for professional coding advice.
- Revenue Code: P7B (ONCOLOGY - OTHER)
- RVU: The RVUs for this code vary based on geographic location and other factors. Consult your specific payer's fee schedule for the most accurate information.
- Global Days: The global period for this code is not explicitly defined and may depend on payer policies and local practices. Consult your payer's guidelines.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not typically apply to this code as it represents the professional component of the service.
- Fee Schedule: Historical fee schedule data is not consistently available publicly and varies widely by location and payer.Consult your payer's historical fee schedules for relevant data.
- Specialties:Oncology, Hematology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center