CPT 96415: Continued Intravenous Chemotherapy Infusion, Per Additional Hour
Medicare pays $29 and commercial payers pay $83 on average nationally for this procedure.
CPT code 96415 is an add-on chemotherapy infusion code describing continued intravenous administration of a chemotherapy drug using an infusion technique for each additional hour beyond the initial hour during the same patient session; service type: chemotherapy infusion administration (intravenous); typical site of service: outpatient infusion center or hospital outpatient department.
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
Nationally, Medicare averages $29.4 for CPT 96415 while BUCA’s mean commercial rate is substantially higher at $82.7, reflecting a roughly $53.3 gap between public and this commercial benchmark. Blue Cross Blue Shield’s mean of $101.6 and Aetna’s mean of $77.1 also sit above Medicare, while Cigna and UnitedHealth Group have means closer to BUCA and below BCBS, illustrating a clear separation between Medicare and major commercial payers.
Dispersion measured as the interquartile spread (P75 minus P25) varies meaningfully: Aetna’s IQR is $50.5, Blue Cross Blue Shield’s is $40.1, BUCA’s is $37.8, Cigna’s is $33.8, and UnitedHealth Group’s is $25.0. UnitedHealth Group therefore shows the tightest middle distribution and Aetna the widest, with BUCA and BCBS indicating moderate commercial variability around their means.