CPT 96416
Global XXX ActiveChemo prolong infuse w/pump
CPT 96416 Billing & Documentation Guide
CPT code 96416 (Chemo prolong infuse w/pump) 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 3.71, and a malpractice RVU of 0.07, a total non-facility RVU of 3.99 and facility RVU of 3.99. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $138.48, though rates vary from $114.66 to $187.73 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96416, 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 96416 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 96416 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 96416
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.21 | 0.21 |
| Practice Expense RVU | 3.71 | 3.71 |
| Malpractice RVU | 0.07 | 0.07 |
| Total RVU | 3.99 | 3.99 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96416
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 | $155.16 | $155.16 | $144.2 - $187.73 | 29 |
| Florida | $135.9 | $135.9 | $128.99 - $141.93 | 3 |
| Georgia | $128.04 | $128.04 | $120.34 - $135.74 | 2 |
| Illinois | $131.25 | $131.25 | $123.81 - $138.47 | 4 |
| Michigan | $126.66 | $126.66 | $122.79 - $130.54 | 2 |
| North Carolina | $124.12 | $124.12 | $124.12 - $124.12 | 1 |
| New York | $148.77 | $148.77 | $126.38 - $159.14 | 5 |
| Ohio | $122.51 | $122.51 | $122.51 - $122.51 | 1 |
| Pennsylvania | $130.96 | $130.96 | $122.98 - $138.93 | 2 |
| Texas | $131.22 | $131.22 | $121.95 - $140.2 | 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 96416
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96416 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 |
| 64450 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 96416
What does CPT code 96416 mean? +
CPT code 96416 represents: Chemo prolong infuse w/pump. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96416? +
The 2026 Medicare national average non-facility payment for CPT 96416 is $138.48. Rates range from $114.66 to $187.73 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96416? +
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 96416? +
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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