CodeMap®  150 North Wacker Drive
Suite 1870
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

PLA Codes

Laboratory Fee Schedule

2019
2018

Physician Fee Schedule

2019
2018

OPPS Fee Schedule

2018

ASC Fee Schedule

2018

APC Codes

2018

DRG Codes

2018

ASP Drug Pricing Files

October 2018
July 2018


CMS Transmittals




96411
Quick jump to procedure code: Printer Friendly Version
96415

Procedure Category: Medicine
Procedure Subcategory: Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and other Highly Complex Drug or Highly Complex Biologic Agent Administration

96413: CHEMO IV INFUSION 1 HR

CPT® 96413: Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug



--

CPT copyright 2017 American Medical Association. All rights reserved.


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

Global Fee $144.72
2018 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2018D Unadjusted OPPS Payment $297.57
2018 APC Code: 5694
Level 4 Drug Administration

2018 OPPS Status Indicator: S

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
16.5%
Z51.11
Encounter for antineoplastic chemotherapy
826-830
837-839
846-848
7.7%
M05.79
Rheumatoid arthritis with rheumatoid factor of multiple sites without organ or systems involvement
545-547
3.7%
M06.09
Rheumatoid arthritis without rheumatoid factor, multiple sites
545-547
2.9%
M06.9
Rheumatoid arthritis, unspecified
545-547
2.5%
Z51.12
Encounter for antineoplastic immunotherapy
826-830
837-839
846-848
1.9%
C90.00
Multiple myeloma not having achieved remission
820-822
823-825
840-842
1.9%
C34.11
Malignant neoplasm of upper lobe, right bronchus or lung
180-182
1.8%
C34.90
Malignant neoplasm of unspecified part of unspecified bronchus or lung
180-182
1.7%
C34.12
Malignant neoplasm of upper lobe, left bronchus or lung
180-182
1.6%
G35
Multiple sclerosis
058-060

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

96413 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 96413
Denied Codes (1)
Effective
Modifier
Accepted (2)
11900 INJECT SKIN LESIONS
04/01/2007 Yes
11901 INJECT SKIN LESIONS >7
04/01/2007 Yes
36000 PLACE NEEDLE IN VEIN
01/01/2006 Yes
36410 NON-ROUTINE BL DRAW 3/> YRS
01/01/2006 Yes
36500 INSERTION OF CATHETER VEIN
10/01/2006 Yes
36591 DRAW BLOOD OFF VENOUS DEVICE
10/01/2015 No
36592 COLLECT BLOOD FROM PICC
10/01/2015 No
61650 EVASC PRLNG ADMN RX AGNT 1ST
01/01/2016 Yes
64450 N BLOCK OTHER PERIPHERAL
01/01/2006 Yes
64486 TAP BLOCK UNIL BY INJECTION
01/01/2015 Yes
64487 TAP BLOCK UNI BY INFUSION
01/01/2015 Yes
64488 TAP BLOCK BI INJECTION
01/01/2015 Yes
64489 TAP BLOCK BI BY INFUSION
01/01/2015 Yes
75893 VENOUS SAMPLING BY CATHETER
10/01/2006 Yes
96360 HYDRATION IV INFUSION INIT
01/01/2009 Yes
96365 THER/PROPH/DIAG IV INF INIT
01/01/2009 Yes
96372 THER/PROPH/DIAG INJ SC/IM
01/01/2009 Yes
96374 THER/PROPH/DIAG INJ IV PUSH
01/01/2009 Yes
96377 APPLICATON ON-BODY INJECTOR
01/01/2017 Yes
96409 CHEMO IV PUSH SNGL DRUG
01/01/2006 Yes
96521 REFILL/MAINT PORTABLE PUMP
01/01/2006 Yes
96522 REFILL/MAINT PUMP/RESVR SYST
01/01/2006 Yes
96523 IRRIG DRUG DELIVERY DEVICE
01/01/2006 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99201 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99202 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99203 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99204 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99205 OFFICE/OUTPATIENT VISIT NEW
01/01/2006 Yes
99211 OFFICE/OUTPATIENT VISIT EST
01/01/2006 No
99212 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99213 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99214 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99215 OFFICE/OUTPATIENT VISIT EST
01/01/2006 Yes
99354 PROLONG E&M/PSYCTX SERV O/P
01/01/2017 Yes
99355 PROLONG E&M/PSYCTX SERV O/P
01/01/2017 Yes
99358 PROLONG SERVICE W/O CONTACT
07/01/2017 Yes
99359 PROLONG SERV W/O CONTACT ADD
07/01/2017 Yes
99455 WORK RELATED DISABILITY EXAM
01/01/2006 Yes
99456 DISABILITY EXAMINATION
01/01/2006 Yes
99483 ASSMT & CARE PLN PT COG IMP
01/01/2018 Yes
99497 ADVNCD CARE PLAN 30 MIN
01/01/2016 Yes
E0781 External ambulatory infus pu
07/01/2010 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
J1642 Inj heparin sodium per 10 u
07/01/2017 Yes
J1644 Inj heparin sodium per 1000u
07/01/2010 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 96413.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 96413

Denied Codes (1)
Effective
Modifier
Accepted (2)
36823 INSERTION OF CANNULA(S)
01/01/2006 Yes
77750 INFUSE RADIOACTIVE MATERIALS
10/01/2012 No
79101 NUCLEAR RX IV ADMIN
01/01/2006 No
79403 HEMATOPOIETIC NUCLEAR TX
01/01/2006 Yes
93018 CARDIOVASCULAR STRESS TEST
01/01/2006 Yes
99217 OBSERVATION CARE DISCHARGE
04/01/2008 Yes
99218 INITIAL OBSERVATION CARE
04/01/2008 Yes
99219 INITIAL OBSERVATION CARE
04/01/2008 Yes
99220 INITIAL OBSERVATION CARE
04/01/2008 Yes
99221 INITIAL HOSPITAL CARE
04/01/2008 Yes
99222 INITIAL HOSPITAL CARE
04/01/2008 Yes
99223 INITIAL HOSPITAL CARE
04/01/2008 Yes
99224 SUBSEQUENT OBSERVATION CARE
01/01/2011 No
99225 SUBSEQUENT OBSERVATION CARE
01/01/2011 No
99226 SUBSEQUENT OBSERVATION CARE
01/01/2011 No
99231 SUBSEQUENT HOSPITAL CARE
04/01/2008 No
99232 SUBSEQUENT HOSPITAL CARE
04/01/2008 No
99233 SUBSEQUENT HOSPITAL CARE
04/01/2008 No
99234 OBSERV/HOSP SAME DATE
04/01/2008 Yes
99235 OBSERV/HOSP SAME DATE
04/01/2008 Yes
99236 OBSERV/HOSP SAME DATE
04/01/2008 Yes
99238 HOSPITAL DISCHARGE DAY
04/01/2008 Yes
99239 HOSPITAL DISCHARGE DAY
04/01/2008 Yes
99281 EMERGENCY DEPT VISIT
04/01/2008 Yes
99282 EMERGENCY DEPT VISIT
04/01/2008 Yes
99283 EMERGENCY DEPT VISIT
04/01/2008 Yes
99284 EMERGENCY DEPT VISIT
04/01/2008 Yes
99285 EMERGENCY DEPT VISIT
04/01/2008 Yes
99291 CRITICAL CARE FIRST HOUR
04/01/2008 Yes
99304 NURSING FACILITY CARE INIT
04/01/2008 Yes
99305 NURSING FACILITY CARE INIT
04/01/2008 Yes
99306 NURSING FACILITY CARE INIT
04/01/2008 Yes
99307 NURSING FAC CARE SUBSEQ
04/01/2008 No
99308 NURSING FAC CARE SUBSEQ
04/01/2008 No
99309 NURSING FAC CARE SUBSEQ
04/01/2008 No
99310 NURSING FAC CARE SUBSEQ
04/01/2008 No
99315 NURSING FAC DISCHARGE DAY
04/01/2008 Yes
99316 NURSING FAC DISCHARGE DAY
04/01/2008 Yes
99318 ANNUAL NURSING FAC ASSESSMNT
04/01/2008 No
99324 DOMICIL/R-HOME VISIT NEW PAT
04/01/2008 Yes
99325 DOMICIL/R-HOME VISIT NEW PAT
04/01/2008 Yes
99326 DOMICIL/R-HOME VISIT NEW PAT
04/01/2008 Yes
99327 DOMICIL/R-HOME VISIT NEW PAT
04/01/2008 Yes
99328 DOMICIL/R-HOME VISIT NEW PAT
04/01/2008 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99334 DOMICIL/R-HOME VISIT EST PAT
04/01/2008 Yes
99335 DOMICIL/R-HOME VISIT EST PAT
04/01/2008 Yes
99336 DOMICIL/R-HOME VISIT EST PAT
04/01/2008 Yes
99337 DOMICIL/R-HOME VISIT EST PAT
04/01/2008 Yes
99341 HOME VISIT NEW PATIENT
04/01/2008 Yes
99342 HOME VISIT NEW PATIENT
04/01/2008 Yes
99343 HOME VISIT NEW PATIENT
04/01/2008 Yes
99344 HOME VISIT NEW PATIENT
04/01/2008 Yes
99345 HOME VISIT NEW PATIENT
04/01/2008 Yes
99347 HOME VISIT EST PATIENT
04/01/2008 Yes
99348 HOME VISIT EST PATIENT
04/01/2008 Yes
99349 HOME VISIT EST PATIENT
04/01/2008 Yes
99350 HOME VISIT EST PATIENT
04/01/2008 Yes
99460 INIT NB EM PER DAY HOSP
01/01/2009 No
99461 INIT NB EM PER DAY NON-FAC
01/01/2009 No
99462 SBSQ NB EM PER DAY HOSP
01/01/2009 No
99463 SAME DAY NB DISCHARGE
01/01/2009 No
99465 NB RESUSCITATION
01/01/2009 No
99466 PED CRIT CARE TRANSPORT
01/01/2009 Yes
99468 NEONATE CRIT CARE INITIAL
01/01/2009 Yes
99469 NEONATE CRIT CARE SUBSQ
01/01/2009 Yes
99471 PED CRITICAL CARE INITIAL
01/01/2009 Yes
99472 PED CRITICAL CARE SUBSQ
01/01/2009 Yes
99475 PED CRIT CARE AGE 2-5 INIT
01/01/2009 Yes
99476 PED CRIT CARE AGE 2-5 SUBSQ
01/01/2009 Yes
99477 INIT DAY HOSP NEONATE CARE
01/01/2009 Yes
99478 IC LBW INF < 1500 GM SUBSQ
01/01/2009 Yes
99479 IC LBW INF 1500-2500 G SUBSQ
01/01/2009 Yes
99480 IC INF PBW 2501-5000 G SUBSQ
01/01/2009 Yes
99485 SUPRV INTERFACILTY TRANSPORT
01/01/2013 Yes
99486 SUPRV INTERFAC TRNSPORT ADDL
01/01/2013 Yes
G0380 Lev 1 hosp type b ed visit
10/01/2008 Yes
G0381 Lev 2 hosp type b ed visit
10/01/2008 Yes
G0382 Lev 3 hosp type b ed visit
10/01/2008 Yes
G0383 Lev 4 hosp type b ed visit
10/01/2008 Yes
G0384 Lev 5 hosp type b ed visit
10/01/2008 Yes
G0406 Inpt/tele follow up 15
07/01/2010 Yes
G0407 Inpt/tele follow up 25
07/01/2010 Yes
G0408 Inpt/tele follow up 35
07/01/2010 Yes
G0425 Inpt/ed teleconsult30
07/01/2010 Yes
G0426 Inpt/ed teleconsult50
07/01/2010 Yes
G0427 Inpt/ed teleconsult70
07/01/2010 Yes
G0508 Crit care telehea consult 60
07/01/2017 Yes
G0509 Crit care telehea consult 50
07/01/2017 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 96413.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 96413


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   96413 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
JORGE ZAMORA-QUEZADA -EDINBURG,TX 2,223
GHASSAN JANO -MUNSTER,IN 2,203
BRAD BALTZ -LITTLE ROCK,AR 2,027
VIKAS MALHOTRA -SPRING HILL,FL 2,005
CRAIG CARSON -EDMOND,OK 1,870

   96413 Top 5 Ordering Organizations National*
UNIVERSITY OPTION CARE LLC-OH 107
RX MANAGEMENT SYSTEMS-TN 25

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 96413*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 1,896,629
Total Services Denied 2017: 77,836 (4.1%)
National Charges Submitted 2017: $816,738,752.48
National Charges Allowed 2017: $249,465,618.42
National Average (No Modifier) Fee Submitted 2017: $431.43
National Average (No Modifier) Fee Allowed 2017: $137.11


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Hematology/oncology
(eff 5/92)
995,542 52.5% $439.97 42,581 4.3%
Rheumatology
(eff 5/92)
361,664 19.1% $360.03 10,444 2.9%
Medical oncology
(eff 5/92)
299,725 15.8% $472.15 11,734 3.9%
Internal medicine 65,696 3.5% $404.49 4,132 6.3%
Hematology
(eff 5/92)
30,494 1.6% $521.57 1,351 4.4%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 1,892,593 99.8% $430.90 73,972 3.9%
Off Campus- Outpatient Hospital 3,229 0.2% $281.69 3,229 100.0%
On Campus-Outpatient Hospital 525 0.0% $434.49 525 100.0%
Independent Clinic 88 0.0% $166.74 0 0.0%
Home 52 0.0% $369.81 30 57.7%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 1,796,834 94.7% $431.43 71,381 4.0%
59 - Distinct Procedural Service 49,329 2.6% $339.49 3,898 7.9%
Q1 26,954 1.4% $506.92 1,427 5.3%
XU 11,379 0.6% $539.36 370 3.3%
Q6 - Physician Services 3,955 0.2% $455.38 164 4.1%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
12/17/2018 12:59:10 34.228.30.69

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.