Summary & Overview
CPT 96423: Intra-arterial Chemotherapy Infusion, Add-on per Hour
CPT code 96423 denotes an add-on procedure for intra-arterial chemotherapy infusion, billed for each additional hour of arterial infusion. This procedure-level code matters nationally because intra-arterial delivery of chemotherapy is used for targeted oncologic therapies that may require extended infusion time, influencing facility workflow, resource utilization, and payer reimbursement practices. Accurate reporting of add-on time-based infusion codes affects payment, quality measurement, and clinical documentation.
Key payers in typical national analyses include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical meaning and service setting, plus what to expect from payer coverage policies and billing practice benchmarks. The publication summarizes common modifiers and specified billing conventions, outlines sites of service where the procedure is typically performed, and highlights implications for reporting time-based add-on chemotherapy services. This content is intended to inform billing staff, oncology practice managers, and health policy analysts about the operational and documentation context tied to CPT code 96423.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and detailed payer-specific policy variations.
Billing Code Overview
CPT code 96423 is an add-on chemotherapy infusion procedure used when a provider administers a chemotherapy agent directly into an artery using an infusion technique. This code is reported for each additional hour of intra-arterial chemotherapy infusion beyond the initial infusion period.
Service Type: Intra-arterial chemotherapy infusion, add-on, per additional hour
Typical Site of Service: Hospital inpatient or outpatient infusion center, ambulatory surgical center, or other procedural setting where intra-arterial chemotherapy infusions are performed
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with unresectable hepatic metastases from colorectal cancer is scheduled for regional intra-arterial chemotherapy infusion. The interventional oncology team places a percutaneous arterial catheter into the hepatic artery and initiates a continuous intra-arterial chemotherapy infusion. The initial hour of infusion is reported with the primary infusion code; each additional hour of infusion is reported using 96423. Typical workflow includes vascular access and catheter placement by an interventional radiologist or oncologic surgeon, pharmacy preparation of the chemotherapeutic agent, monitoring in an outpatient interventional suite or hospital infusion unit, hourly documentation of infusion time, and nursing monitoring for hemodynamic stability and local/systemic toxicities.
Typical site of service: outpatient hospital outpatient infusion center, ambulatory surgical center, or inpatient interventional radiology suite.
Service type: procedure — arterial chemotherapy infusion, add-on hourly billing for each additional hour of infusion beyond the first.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient visit for evaluation and management | When a significant, separately identifiable E/M service is provided on the same day as the infusion and meets documentation requirements |