How much does Medicare pay for CPT 96402?

Medicare allowed an average of $34.55 per service and paid $26.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $119.61, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96402?

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle. It was billed 259,895 times to 110,182 Medicare beneficiaries by 4,581 providers in 2024.

Does 96402 pay differently in an office than a hospital?

Yes. The allowed amount averaged $34.55 in an office setting and $40.77 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 96402 most?

Urology, with 99,004 services from 2,196 clinicians. Next are Hematology-Oncology, Medical Oncology, Nurse Practitioner.

CPT 96402

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle

$34.55Medicare-allowed amount per service, averaged across 259,895 services

Providers submitted

$119.61

Asking price, not received

Medicare allowed

$34.55

The fee schedule figure

Medicare paid

$26.27

Balance is patient coinsurance

Providers submitted an average of $119.61 for this code and Medicare allowed $34.55 — 3.5× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $26.27 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $34.55
Hospital / facility: $40.77

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 259,878 services were billed in an office setting and 17 in a facility.

Services: 259,895
Beneficiaries: 110,182
Providers billing it: 4,581
Total allowed: $8,979,372

What Medicare pays for CPT 96402

Across 259,895 services billed by 4,581 providers to 110,182 beneficiaries, Medicare allowed an average of $34.55 per service. That is 2.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 96402

Specialty	Services	Beneficiaries	Avg allowed	Providers
Urology	99,004	53,377	$35.20	2,196
Hematology-Oncology	98,677	30,479	$34.93	1,307
Medical Oncology	31,036	10,087	$34.53	449
Nurse Practitioner	11,424	6,222	$28.94	248
Physician Assistant	8,883	5,297	$29.79	195
Internal Medicine	3,779	1,525	$34.66	71
Radiation Oncology	2,837	1,596	$34.34	61
Hematology	2,741	893	$36.39	28
Gynecological Oncology	284	88	$33.08	5
Hematopoietic Cell Transplantation and Cellular Therapy	235	204	$33.24	5
Hospitalist	228	118	$40.56	5
Endocrinology	202	112	$34.32	2
Obstetrics & Gynecology	196	27	$32.81	2
General Surgery	164	69	$39.40	2
Hospice and Palliative Care	106	45	$35.38	2

96402 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
Florida	31,640	$34.03	$26.34	446
California	31,198	$39.82	$26.40	446
Texas	19,411	$33.41	$26.22	386
New York	11,539	$39.50	$26.51	218
Maryland	11,133	$36.29	$24.96	143
Illinois	10,647	$34.06	$26.39	201
Virginia	10,158	$34.57	$25.66	196
New Jersey	9,987	$38.92	$26.03	168
Arizona	8,785	$33.55	$26.19	151
Georgia	7,680	$31.73	$26.51	140
Tennessee	7,470	$31.11	$25.83	138
Pennsylvania	6,969	$33.67	$25.94	151
Arkansas	5,794	$29.15	$24.89	71
North Carolina	5,731	$32.30	$25.64	126
Ohio	5,408	$32.14	$26.32	107
South Carolina	5,095	$32.47	$25.98	84
Minnesota	4,534	$35.29	$26.42	99
Mississippi	4,313	$29.91	$25.48	61
Indiana	4,297	$31.46	$25.73	104
Nevada	4,276	$34.25	$25.96	53
Alabama	4,123	$30.26	$26.27	70
Nebraska	4,052	$31.03	$25.92	66
Washington	3,677	$35.10	$26.30	73
Kansas	3,580	$31.23	$25.33	43
Colorado	3,548	$35.32	$25.35	72
Oklahoma	3,286	$30.89	$25.67	69
Michigan	3,248	$33.41	$26.48	71
Iowa	3,226	$31.28	$25.77	63
Oregon	2,803	$35.24	$25.65	63
Missouri	2,706	$31.67	$25.18	80
Massachusetts	2,115	$37.06	$25.95	59
Louisiana	2,021	$30.94	$25.43	49
Connecticut	1,857	$37.68	$26.20	46
New Mexico	1,817	$32.44	$26.61	28
Wisconsin	1,693	$32.38	$25.89	44
Alaska	1,382	$37.70	$25.14	22
Delaware	1,378	$34.94	$25.18	23
Kentucky	1,310	$31.21	$25.64	28
Utah	1,150	$32.27	$25.83	17
Maine	863	$34.28	$25.93	12
South Dakota	790	$32.51	$25.16	22
Idaho	671	$31.50	$26.07	14
New Hampshire	451	$35.75	$26.27	12
Hawaii	396	$37.35	$26.30	9
North Dakota	321	$33.08	$24.14	4
Montana	311	$36.07	$25.56	9
U.S. Virgin Islands	218	$35.33	$24.71	3
Wyoming	185	$33.06	$25.95	5
District of Columbia	156	$40.13	$26.29	2
Guam	151	$38.34	$27.47	1
West Virginia	121	$30.25	$25.39	5
Vermont	96	$33.81	$25.07	2
Rhode Island	80	$36.68	$27.19	4
Puerto Rico	48	$34.67	$27.54	2

Related codes

96413Administration of chemotherapy into vein$125.25
96401Administration of non-hormonal anti-neoplastic chemotherapy under skin$70.79
96415Administration of chemotherapy into vein$26.93
96417Administration of additional new drug or substance into vein$62.30
96411Administration of additional new drug or substance into vein$52.81
96405Administration of chemotherapy into growth$68.35
96409Administration of chemotherapy into vein$99.73
96416Administration of prolonged chemotherapy into vein$130.62
96450Administration of chemotherapy into fluid-filled space between the tis$71.36

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.