CPT 96413: chemotherapy infusion, first hour
96413 reports the initial intravenous infusion of a chemotherapy or other highly complex drug, covering the first hour. CMS applies the chemotherapy administration codes to more than cancer drugs, so the drug name alone does not settle which family you bill.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 96413 is the initial chemotherapy infusion code, with one initial service per encounter and 96415 and 96417 as add-ons. CMS counts anti-neoplastic drugs, monoclonal antibodies and other biologic response modifiers as chemotherapy administration. The MUE is 1 unit a day, and the drug is billed on its own line.
What does CPT 96413 report?
96413 reports an intravenous infusion of a chemotherapy or other highly complex drug, as the initial service, for up to the first hour. The October 2026 fee schedule file (RVU26D) lists it as active, status A, with global period XXX and a PC/TC indicator of 5, an incident-to service.
The 2026 NCCI Policy Manual lists it with 96360, 96365, 96374 and 96409 as initial-service codes, and only one is reported per encounter unless the drugs must go in at separate IV sites.
| Code | CMS short label | Work RVU | Total RVU, non-facility | Global |
|---|---|---|---|---|
| 96409 | Chemo iv push sngl drug | 0.24 | 3.13 | XXX |
| 96413 | Chemo iv infusion 1 hr | 0.28 | 3.99 | XXX |
| 96415 | Chemo iv infusion addl hr | 0.19 | 0.85 | ZZZ |
| 96417 | Chemo iv infus each addl seq | 0.21 | 1.99 | ZZZ |
Which drugs count as chemotherapy administration?
Chapter 12, section 30.5 D, of the Medicare Claims Processing Manual says the chemotherapy administration codes apply to parenteral non-radionuclide anti-neoplastic drugs. They also apply to anti-neoplastic agents given for non-cancer diagnoses, with cyclophosphamide for autoimmune conditions as the example, and to monoclonal antibodies and other biologic response modifiers.
The manual names infliximab, rituximab, alemtuzumab, gemtuzumab and trastuzumab as commonly considered monoclonal antibodies, and leuprolide acetate and goserelin acetate as hormonal antineoplastics. It says the list is not complete, that the MAC may give more guidance, and that complexity is weighed, not the drug name alone.
It also draws one line out: anti-anemia drugs and anti-emetic drugs given by injection or infusion to cancer patients are not chemotherapy administration. They belong with 96365 and its family. The drugs, such as J9271 and J1745, are separate lines.
What is included in the 96413 payment?
Chapter 12 lists six items that are not billed separately when done to facilitate the chemotherapy: local anesthesia, IV access, access to an indwelling IV, subcutaneous catheter or port, the flush at the end, standard tubing, syringes and supplies, and preparation of the chemotherapy agent.
NCCI chapter XI adds that flushing an implanted port is integral, so 96523 is not reported for it. A significant, separately identifiable E/M visit can be billed with modifier 25, and a different diagnosis is not required. 99211 cannot be reported on the same day, because the chemotherapy codes were valued to include it.
How do the first hour and the add-on codes work?
Chapter 12 allows the add-on for each additional hour (96415) only when the infusion runs more than 30 minutes past the first hour. A single-drug infusion of 1 hour 45 minutes is 96413 plus one unit of 96415. A second, different drug infused in sequence is reported with 96417.
The initial code is the one that best describes the primary reason for the visit, whatever order the drugs were given in.
An anti-emetic or other non-chemotherapy drug infused at the same time as the chemotherapy can be reported with 96368, once per encounter, under NCCI chapter XI.
Who reports 96413: the practice or the hospital?
NCCI chapter XI says practitioners report these services for physician office care and not in a facility such as a hospital outpatient department or emergency department, where the hospital reports them. RVU26D agrees: 96413 carries a facility NA indicator, meaning it is rarely or never performed in the facility setting.
Under OPPS, chapter 4, section 230.2, tells hospitals to report one initial drug administration per vascular access site per encounter, including an observation stay over more than one calendar day.
How does 96413 sit on the claim?
On a CMS-1500, 96413 goes in item 24D with 1 in item 24G. On a UB-04, the HCPCS code goes in form locator 44 and units in form locator 46. The NCCI MUE is 1 unit per date of service, indicator 3, in both the practitioner and outpatient hospital tables for Q4 2026.
Because the PC/TC indicator is 5, modifiers 26 and TC cannot be used on it. A second initial code on the same day takes a PTP-associated modifier only when the protocol needs two IV sites or the patient returns for a separate service.
Where do chemo infusion hours and drugs go?
A chemotherapy infusion is one initial line, 96413 in Item 24D with 1 unit in Item 24G and a pointer in Item 24E to the cancer diagnosis. Added hours use the add-on code on a second line with the number of extra hours in Item 24G. The drug sits on its own line with the drug code and units.
On the hospital bill, the infusion revenue code is in FL 42, 96413 in FL 44, the date in FL 45 and units in FL 46, with the drug under its own revenue code. RVU26D gives 96413 status A and global XXX, and the MUE table allows 1 per date with indicator 3.
Example: A patient with lung cancer receives a 2 hour 40 minute infusion on 10/16. Line 1 is 96413, pointer A (C34.90), 1 unit, $540.00. Line 2 is the add-on for the extra time with 2 units, and line 3 is the drug. A missing time log leaves the add-on unsupported.
What denials follow 96413?
| CARC | RARC | What X12 says, and what to check |
|---|---|---|
| 97 | N20 | Benefit included in another service, or the service is not payable with another service on the same date. Check for a second initial code with no modifier. |
| 18 | Exact duplicate claim or service, used with group code OA. Check for a resubmission or two units billed. | |
| 197 | Precertification or authorization absent. Confirm the approval covers the drug and the date. | |
| 50 | Not deemed medically necessary. Send the diagnosis and the treatment plan. | |
| 151 | The information does not support this many or this frequency of services. Check units against the infusion times. |
If these denials keep coming back, our denial management team can work them.
Related codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner and outpatient hospital tables, effective 10-01-2026 · CMS
- 2026 NCCI Medicare Policy Manual, Chapter XI, section N: chemotherapy administration · CMS
- Medicare Claims Processing Manual, Chapter 12, section 30.5: chemotherapy administration and nonchemotherapy injections and infusions · CMS
- Medicare Claims Processing Manual, Chapter 4, section 230.2: drug administration under OPPS · CMS
- Medicare Claims Processing Manual, Chapter 25: UB-04 form locators 42 to 46 · CMS
- Medicare Claims Processing Manual, Chapter 26: CMS-1500 items 24A to 24G · CMS
- X12 claim adjustment reason codes · X12
- X12 remittance advice remark codes · X12
We check every rule, code and deadline against the official source. See our editorial policy.
Common questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How do I bill the first hour of chemotherapy infusion?
Bill 96413 once as the initial service, with 1 unit, and put the drug on its own HCPCS line with its units. Add 96415 only when the infusion runs more than 30 minutes past the first hour, and 96417 for each further sequential drug. Flush, IV access and chemotherapy preparation are included.
02Does CMS count infliximab as chemotherapy administration?
Chapter 12, section 30.5 D, names infliximab among the monoclonal antibodies commonly considered to fall under the chemotherapy administration codes. It says the list is not complete and that the MAC may add guidance, so confirm your contractor's view before choosing 96413 over 96365 for a biologic.
03Is an anti-emetic infusion for a cancer patient billed with 96413?
No. The manual says anti-emetic and anti-anemia drugs given by injection or infusion to cancer patients are not chemotherapy administration. A concurrent anti-emetic infusion can be reported with 96368 once per encounter under NCCI chapter XI, and the primary infusion keeps 96413.
04Can I bill 96413 and an E/M on the same day?
Yes, when the visit is significant and separately identifiable, with modifier 25 on the E/M code. Chapter 12 says a different diagnosis is not required for the E/M. The one exception is 99211, which cannot be reported with 96413 because the chemotherapy codes were valued to include it.
05How many units of 96413 can I bill in one day?
One. The October 2026 NCCI MUE tables list 1 unit per date of service for 96413 in both the practitioner and outpatient hospital tables, indicator 3. Extra time is reported with 96415, and a second drug in sequence with 96417, not more units of 96413.
Chemotherapy administration claims bundled or denied?
We check the initial code, add-on hours and the drug lines before chemotherapy claims go out.