CPT 96542
Global XXX ActiveChemotherapy injection
CPT 96542 Billing & Documentation Guide
CPT code 96542 (Chemotherapy injection) is classified under Infusion/Chemotherapy with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.75, a non-facility practice expense RVU of 3.21, and a malpractice RVU of 0.06, a total non-facility RVU of 4.02 and facility RVU of 1.07. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $139.17, though rates vary from $118.18 to $183.49 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 96542, 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 96542 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 96542 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 96542
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense RVU | 3.21 | 0.26 |
| Malpractice RVU | 0.06 | 0.06 |
| Total RVU | 4.02 | 1.07 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 96542
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 | $153.9 | $37.31 | $144.06 - $183.49 | 29 |
| Florida | $136.52 | $37.66 | $130.56 - $141.73 | 3 |
| Georgia | $129.78 | $35.78 | $123.08 - $136.47 | 2 |
| Illinois | $132.57 | $37.36 | $126.07 - $138.89 | 4 |
| Michigan | $128.55 | $36.03 | $125.2 - $131.89 | 2 |
| North Carolina | $126.36 | $34.43 | $126.36 - $126.36 | 1 |
| New York | $148.58 | $38.65 | $128.32 - $157.86 | 5 |
| Ohio | $124.96 | $35 | $124.96 - $124.96 | 1 |
| Pennsylvania | $132.44 | $35.93 | $125.37 - $139.51 | 2 |
| Texas | $132.61 | $35.6 | $124.48 - $140.31 | 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 96542
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 96542 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 |
| 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 |
| 61070 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 62270 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 96542
What does CPT code 96542 mean? +
CPT code 96542 represents: Chemotherapy injection. It's in the Infusion/Chemotherapy category with a global period of XXX.
What is the Medicare reimbursement for CPT 96542? +
The 2026 Medicare national average non-facility payment for CPT 96542 is $139.17. Rates range from $118.18 to $183.49 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 96542? +
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 96542? +
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 June 2, 2026.
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