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CPT 96413: Intravenous Chemotherapy Infusion, Initial Hour
CPT code 96413 represents the intravenous administration of chemotherapy using an infusion technique for the initial hour of a single or initial drug. This code is central to oncology care delivery and reimbursement because it captures the facility or clinician effort involved in delivering the first hour of an IV chemotherapy infusion, a common and resource-intensive treatment component for many cancers. Nationally, accurate use of this code affects claims adjudication, payment consistency, and clinical reporting across oncology care settings.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of clinical context for use of 96413, typical sites of service where it is billed, and how it relates to adjacent infusion and supportive care codes. The publication summarizes common payer coverage considerations, lists frequently used modifiers for billing workflows, and situates 96413 among related chemotherapy and infusion codes such as additional-hour and sequential-infusion codes.
This summary provides clinicians, billing professionals, and policy analysts with practical reference material on the clinical purpose of CPT code 96413, payer scope, and coding relationships that inform billing and reporting for initial intravenous chemotherapy infusions.
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Billing Code Overview
CPT code 96413 describes an intravenous chemotherapy administration using an infusion technique for the initial hour of a single or initial chemotherapy drug or substance. The procedure covers the therapeutic delivery of cytotoxic or other antineoplastic agents by intravenous infusion aimed at treating malignant disease.
Service Type: Chemotherapy administration (intravenous infusion), initial hour
Typical Site of Service: Hospital outpatient infusion center, physician office infusion suite, or ambulatory infusion center
National Reimbursement Benchmarks
Medicare's national mean for CPT 96413 sits at $139.20, substantially below BUCA's average commercial mean of $385.80, indicating a roughly $246.60 gap between public and that commercial benchmark. This spread highlights how commercial contracts can pay multiple times Medicare levels for the same infusion service, with BUCA positioned near the upper-middle of commercial averages.
Dispersion (P75−P25) varies meaningfully across payers. Blue Cross Blue Shield shows the widest interquartile spread at $244.40 ($598.70−$354.30), followed by BUCA at $186.40 ($460.30−$263.90). Aetna and UnitedHealth Group are tighter at $136.20 and $123.00 respectively, while Cigna's spread is $145.10. These differences reflect greater variability in negotiated commercial rates versus relatively narrow Medicare locality variation.