CPT 96401
Global XXX ActiveChemo anti-neopl sq/im
CPT 96401 Billing & Documentation Guide
CPT code 96401 (Chemo anti-neopl sq/im) is classified under Infusion/Chemotherapy with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.21, a non-facility practice expense RVU of 1.9, and a malpractice RVU of 0.04, a total non-facility RVU of 2.15 and facility RVU of 2.15. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $74.53, though rates vary from $62.22 to $100.01 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96401, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 96401 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 96401 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 96401
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.21 | 0.21 |
| Practice Expense RVU | 1.9 | 1.9 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 2.15 | 2.15 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96401
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $83.08 | $83.08 | $77.4 - $100.01 | 29 |
| Florida | $73.29 | $73.29 | $69.69 - $76.46 | 3 |
| Georgia | $69.16 | $69.16 | $65.21 - $73.12 | 2 |
| Illinois | $70.91 | $70.91 | $67.04 - $74.61 | 4 |
| Michigan | $68.49 | $68.49 | $66.46 - $70.51 | 2 |
| North Carolina | $67.08 | $67.08 | $67.08 - $67.08 | 1 |
| New York | $79.96 | $79.96 | $68.24 - $85.4 | 5 |
| Ohio | $66.3 | $66.3 | $66.3 - $66.3 | 1 |
| Pennsylvania | $70.66 | $70.66 | $66.53 - $74.8 | 2 |
| Texas | $70.77 | $70.77 | $66.01 - $75.35 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 96401
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96401 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0708T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 11900 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 11901 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 64450 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64454 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64473 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 64474 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96401
What does CPT code 96401 mean? +
CPT code 96401 represents: Chemo anti-neopl sq/im. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96401? +
The 2026 Medicare national average non-facility payment for CPT 96401 is $74.53. Rates range from $62.22 to $100.01 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96401? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 96401? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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