Summary & Overview
CPT 96402: Subcutaneous or Intramuscular Hormonal Antineoplastic Administration
CPT code 96402 denotes the clinical procedure of administering a hormonal anti‑neoplastic drug via subcutaneous or intramuscular injection. This code captures parenteral delivery of systemic hormonal therapy outside of intravenous infusion, and it is used across ambulatory oncology and outpatient practice settings. Accurate use of this code is important for coding consistency, clinical documentation, and payer processing for injectable hormonal cancer treatments.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical context for this administration route, typical sites of service, and the implications for claims coding. The publication also covers payer-specific coverage patterns, common billing modifiers encountered with injectable oncology services, and benchmarks for utilization where available.
This summary provides clinicians, coders, and billing professionals with the necessary context to identify when 96402 is appropriate, understand where the service is typically rendered, and what to expect from major national payers. Data not available in the input are noted where applicable, and the content focuses on national-level relevance rather than state-specific policy.
Billing Code Overview
CPT code 96402 describes the administration of a hormonal anti‑neoplastic (anti‑cancer) drug by subcutaneous (under the skin) or intramuscular (into muscle) injection. This procedure involves a clinician delivering a systemic hormonal therapy intended to treat neoplastic disease.
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Service type: Parenteral chemotherapy administration (subcutaneous or intramuscular) of a hormonal antineoplastic agent
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Typical site of service: Ambulatory clinic, oncology infusion center, outpatient hospital department, or physician office where injections are administered
Data not available in the input regarding associated taxonomies, ICD-10 diagnoses, or related codes.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with metastatic estrogen receptor–positive breast cancer presents to the outpatient oncology clinic for scheduled systemic therapy. The oncologist prescribes a hormonal anti-neoplastic agent formulated for parenteral administration. After a focused review of symptoms, medication reconciliation, and confirmation of consent, the nurse prepares the medication for parenteral delivery. The provider administers the agent via subcutaneous injection into the abdomen or thigh, or via intramuscular injection into the deltoid or gluteal muscle, depending on formulation and absorption requirements. Vital signs and site assessment are documented before and after administration; the patient is observed briefly for immediate adverse reactions. The encounter is billed using 96402 for subcutaneous or intramuscular administration of a hormonal anti-neoplastic drug.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a distinct E/M visit is performed and documented on the same day as 96402. |