CPT 96406: Intralesional Chemotherapy for >7 Lesions
Medicare pays $137 and commercial payers pay $217 on average nationally for this procedure.
CPT code 96406 describes intralesional chemotherapy administration when a provider injects chemotherapeutic agent(s) directly into a lesion or tumor and documents treatment of more than seven lesions; this represents a procedural oncology service typically performed in an outpatient oncology clinic or physician office as part of lesion-directed cancer therapy.
For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Antibody-Drug Conjugates, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only).
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National Reimbursement Benchmarks
Medicare's mean rate of $137.4 sits slightly below BUCA's average commercial mean of $217, illustrating a notable gap between government and aggregated commercial pricing for CPT 96406. The commercial mean landscape varies: Blue Cross Blue Shield's mean is substantially above both, while Aetna and Cigna cluster below UnitedHealth Group and BCBS, positioning BUCA between commercial extremes and Medicare.
Dispersion measured by the interquartile range (P75−P25) is widest for Blue Cross Blue Shield at $194 ($380.2−$168.6), followed by BUCA at $167 ($286.9−$122.0) and UnitedHealth Group at $99.4 ($192.6−$93.2). The tightest spreads are Aetna at $89 ($112.0−$22.0) and Cigna at $116.1 ($183.0−$64.6), indicating Blue Cross Blue Shield and BUCA have the greatest variability in commercial payments while Aetna shows the most compressed middle 50%.