CPT 96402
Global XXX ActiveChemo hormon antineopl sq/im
CPT 96402 Billing & Documentation Guide
CPT code 96402 (Chemo hormon antineopl 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 0.19, a non-facility practice expense RVU of 0.95, and a malpractice RVU of 0.02, a total non-facility RVU of 1.16 and facility RVU of 1.16. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $40.16, though rates vary from $33.95 to $53.16 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96402, 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 96402 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 2 units of 96402 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 96402
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.19 | 0.19 |
| Practice Expense RVU | 0.95 | 0.95 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.16 | 1.16 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96402
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 | $44.48 | $44.48 | $41.59 - $53.16 | 29 |
| Florida | $39.48 | $39.48 | $37.68 - $41.07 | 3 |
| Georgia | $37.43 | $37.43 | $35.45 - $39.41 | 2 |
| Illinois | $38.3 | $38.3 | $36.36 - $40.16 | 4 |
| Michigan | $37.08 | $37.08 | $36.07 - $38.09 | 2 |
| North Carolina | $36.38 | $36.38 | $36.38 - $36.38 | 1 |
| New York | $42.95 | $42.95 | $36.96 - $45.72 | 5 |
| Ohio | $35.99 | $35.99 | $35.99 - $35.99 | 1 |
| Pennsylvania | $38.2 | $38.2 | $36.11 - $40.29 | 2 |
| Texas | $38.24 | $38.24 | $35.84 - $40.52 | 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 96402
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96402 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 96402
What does CPT code 96402 mean? +
CPT code 96402 represents: Chemo hormon antineopl sq/im. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96402? +
The 2026 Medicare national average non-facility payment for CPT 96402 is $40.16. Rates range from $33.95 to $53.16 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96402? +
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 96402? +
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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