Find policies, billing codes, payers, states, and providers
CPT 96406: Intralesional Chemotherapy for More Than Seven Lesions
CPT code 96406 represents intralesional chemotherapy administration when a clinician injects chemotherapy directly into a lesion or tumor and treats more than seven lesions. This procedure code captures a specific, localized route of chemotherapy that differs clinically and operationally from systemic infusion or intralesional treatment of fewer lesions. Nationally, precise coding supports accurate clinical documentation, claim adjudication, and distinctions between limited and extensive lesion-directed therapy.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The publication outlines payer coverage considerations and coding differentiation between 96406 and related code 96405 (used for up to and including seven lesions).
Readers will find a concise clinical context for intralesional chemotherapy, guidance on when 96406 applies based on the number of lesions treated, and an overview of common billing considerations such as sites of service and where this procedure typically occurs. The report also summarizes related procedural coding relationships and ICD-10 diagnosis contexts relevant to malignancies of the skin and secondary neoplasms. Data not available in the input for some specific benchmark metrics and payer-specific reimbursement rates.
Customize your policy alerts
Sign up for cpt 96406 policy alerts
Get alerted when payer policies referencing 96406 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 96406 describes intralesional chemotherapy administration when the provider administers chemotherapy directly into a lesion or tumor and treats more than 7 lesions. This procedure is a form of localized chemotherapy delivered by injection into skin or subcutaneous tumors.
Service Type: Intralesional chemotherapy administration for more than 7 lesions
Typical Site of Service: Outpatient clinic, ambulatory surgical center, or dermatologist/oncologist office
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%.