2025 CPT code 96423
(Active) Effective Date: N/A Revision Date: N/A Medicine - Chemotherapy administration, intra-arterial; infusion technique 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
This add-on code reports each additional hour of intra-arterial chemotherapy infusion, beyond the initial hour (96422).
Modifiers 59 (Distinct Procedural Service) may be appended if the service is distinct from other services performed on the same day.Other modifiers may be needed based on specific circumstances as defined in the CPT manual.
Medical necessity is established by the presence of a malignant or other condition that would benefit from this targeted drug delivery method. The documentation must clearly justify the choice of intra-arterial infusion over other routes of administration.Specific clinical indicators will depend upon the diagnosis and treatment goals.
The physician or other qualified healthcare professional is responsible for overseeing the entire procedure, including patient assessment, informed consent, safety monitoring, and direct supervision of the staff administering the infusion.Advanced practice training and competency are typically required for staff involved in this type of highly complex infusion.
- Medicine Services and Procedures > Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration
- Add-on code to 96422
In simple words: This code is for extra time spent giving chemotherapy drugs directly into an artery. It's only used if the treatment lasts longer than the first hour, and only for each extra hour (or part of an hour, after 30 minutes).
CPT code 96423, an add-on code, represents each additional hour of intra-arterial infusion of chemotherapy or other highly complex drugs/biologic agents.It follows the initial hour of infusion reported with 96422. The code is used only when the infusion extends beyond the first hour in increments of 30 minutes or more. This procedure involves administering the chemotherapeutic agent into an artery directly supplying the target area, allowing for immediate drug delivery.The physician or qualified healthcare professional must directly supervise the procedure, including patient assessment, consent, safety oversight, and staff supervision.This is distinct from other infusions due to the higher risk of adverse reactions requiring frequent monitoring and potential adjustments to infusion rates.
Example 1: A patient with advanced liver cancer undergoes intra-arterial hepatic artery infusion of chemotherapy. The initial hour is coded 96422, and each subsequent hour is coded 96423. The patient receives 3 hours of infusion, requiring two instances of 96423. , A patient with a localized extremity tumor receives intra-arterial infusion chemotherapy. The first hour is billed with 96422; additional hours over 30 minutes are billed with 96423. 2.5 hours of infusion requires 1 instance of 96423., A patient receives intra-arterial chemotherapy for a brain tumor.The initial hour is coded 96422.The infusion lasts 2 hours and 15 minutes, therefore one instance of 96423 is billed.
Detailed documentation is required, including:patient demographics; diagnosis; type and amount of chemotherapeutic agent administered; infusion site, access method; total infusion time; any adverse events during the procedure; physician's orders and notes; nurse's notes describing the process and monitoring; and any relevant images or lab results.
** This code is specifically for intra-arterial infusion.It should not be used for other routes of administration.Always ensure accurate documentation supports the use of this add-on code to prevent payment denials.
- Revenue Code: P7B (ONCOLOGY - OTHER)
- RVU: Information not provided in source data.Consult the current year's CPT codebook for RVU values.
- Global Days: Not applicable to this add-on code. Global surgical periods are usually associated with surgical procedures rather than infusion services.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier does not apply to this code because this is an add-on code that is always billed in association with a professional component (PC).
- Fee Schedule: Historical fee schedule information is not available from the provided data. Consult fee schedules and historical CPT codebooks for that information.
- Specialties:Oncology, Interventional Radiology, Vascular Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center