CPT 96409
Global XXX ActiveChemo iv push sngl drug
CPT 96409 Billing & Documentation Guide
CPT code 96409 (Chemo iv push sngl drug) is classified under Infusion/Chemotherapy with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.24, a non-facility practice expense RVU of 2.83, and a malpractice RVU of 0.06, a total non-facility RVU of 3.13 and facility RVU of 3.13. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $108.54, though rates vary from $90.24 to $146.28 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96409, 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 96409 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 1 units of 96409 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 96409
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.24 | 0.24 |
| Practice Expense RVU | 2.83 | 2.83 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 3.13 | 3.13 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96409
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 | $121.24 | $121.24 | $112.83 - $146.28 | 29 |
| Florida | $106.75 | $106.75 | $101.39 - $111.48 | 3 |
| Georgia | $100.6 | $100.6 | $94.72 - $106.48 | 2 |
| Illinois | $103.21 | $103.21 | $97.45 - $108.7 | 4 |
| Michigan | $99.6 | $99.6 | $96.58 - $102.61 | 2 |
| North Carolina | $97.49 | $97.49 | $97.49 - $97.49 | 1 |
| New York | $116.57 | $116.57 | $99.22 - $124.64 | 5 |
| Ohio | $96.34 | $96.34 | $96.34 - $96.34 | 1 |
| Pennsylvania | $102.82 | $102.82 | $96.68 - $108.95 | 2 |
| Texas | $102.98 | $102.98 | $95.9 - $109.81 | 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 96409
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96409 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 |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36410 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 36500 | 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 |
| 37202 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 96409
What does CPT code 96409 mean? +
CPT code 96409 represents: Chemo iv push sngl drug. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96409? +
The 2026 Medicare national average non-facility payment for CPT 96409 is $108.54. Rates range from $90.24 to $146.28 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96409? +
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 96409? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team