2025 CPT code 96425
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Medicine - Chemotherapy administration, intra-arterial 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, intra-arterial infusion, initiation of prolonged infusion (more than 8 hours) using a portable or implantable pump.
Modifiers 59 (distinct procedural service) and others may be applicable depending on the circumstances. Consult the CPT manual for appropriate modifier usage.
Intra-arterial chemotherapy infusion is medically necessary when other treatment options are not feasible or have failed.The method may be selected when localized administration is needed to minimize systemic toxicity, and prolonged infusion is used for chemotherapeutic agents where toxicity is related to peak serum levels.
The physician or qualified healthcare professional is responsible for patient assessment, obtaining informed consent, overseeing patient safety, directly supervising staff involved in the infusion process, and making adjustments to the infusion rate as needed.The provider must have the expertise and training necessary for administering chemotherapy.
- 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 administration codes (96401-96549)
In simple words: This code describes starting a long-lasting (over 8 hours) chemotherapy treatment given directly into an artery using a special pump. The doctor sets the pump to carefully control the amount of medicine given.
This CPT code reports the initiation of a prolonged intra-arterial chemotherapy infusion (lasting more than 8 hours) using a portable or implantable pump.The physician or qualified healthcare professional administers the chemotherapeutic agent via an intra-arterial catheter, directly into the artery supplying the target treatment area.The infusion is initiated by setting the pump to deliver a controlled amount of drug per hour. This technique is advantageous as it delivers the drug directly to the tumor and allows for prolonged infusion to minimize toxicity related to peak serum levels.Preparation of the chemotherapy agent is included and not reported separately. Refilling and maintenance of the pump are reported separately using codes 96521-96523.
Example 1: A patient with inoperable liver cancer receives intra-arterial hepatic artery infusion of chemotherapy for more than 8 hours via an implantable pump. This code would be used to report the initiation of the infusion., A patient with advanced colorectal cancer undergoes intra-arterial infusion chemotherapy delivered through a portable pump for more than 8 hours, targeting the tumor-feeding artery. Code 96425 is used for the initiation of the infusion., A patient with recurrent brain tumor receives intra-arterial chemotherapy via an implanted reservoir and pump system for more than 8 hours. Code 96425 is reported for the initiation of this treatment.
* Detailed medical history of the patient, including diagnosis and stage of cancer.* Documentation of the need for intra-arterial chemotherapy (e.g., inoperable tumor, metastatic disease).* Specific chemotherapeutic agent administered and its dosage.* Documentation of the type of infusion pump used (portable or implantable).* Verification of the infusion duration (more than 8 hours).* Detailed record of patient monitoring during the infusion (vital signs, adverse effects).* Evidence of informed consent from the patient.
** This code is for the initiation of the prolonged infusion only.Subsequent infusions, refills, or maintenance of the pump are reported with other appropriate codes. The fluid used to administer the drug is considered incidental and is not separately reportable.
- Revenue Code: P7B (ONCOLOGY - OTHER)
- RVU: This information is not available in the provided source.Refer to CMS guidelines or a relevant fee schedule for RVU values and reimbursement information.
- Global Days: Not applicable. This is a single procedure code, not a global package.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is not a procedure with separate professional and technical components.
- Fee Schedule: This information is not available in the provided source. Refer to historical fee schedules and Medicare claims data for historical fee information.
- Specialties:Oncology, Hematology, Interventional Radiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center