How much does Medicare pay for CPT 96405?

Medicare allowed an average of $68.35 per service and paid $51.85 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $189.53, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96405?

Administration of chemotherapy into growth, 1-7. It was billed 15,692 times to 8,141 Medicare beneficiaries by 354 providers in 2024.

Does 96405 pay differently in an office than a hospital?

Yes. The allowed amount averaged $68.90 in an office setting and $25.88 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 96405 most?

Dermatology, with 10,489 services from 251 clinicians. Next are Physician Assistant, Micrographic Dermatologic Surgery, Nurse Practitioner.

CPT 96405

Administration of chemotherapy into growth, 1-7

$68.35Medicare-allowed amount per service, averaged across 15,692 services

Providers submitted

$189.53

Asking price, not received

Medicare allowed

$68.35

The fee schedule figure

Medicare paid

$51.85

Balance is patient coinsurance

Providers submitted an average of $189.53 for this code and Medicare allowed $68.35 — 2.8× 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 $51.85 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $68.90
Hospital / facility: $25.88

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 15,490 services were billed in an office setting and 202 in a facility.

Services: 15,692
Beneficiaries: 8,141
Providers billing it: 354
Total allowed: $1,072,548

What Medicare pays for CPT 96405

Across 15,692 services billed by 354 providers to 8,141 beneficiaries, Medicare allowed an average of $68.35 per service. That is 1.9 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 96405

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	10,489	5,580	$71.47	251
Physician Assistant	1,504	769	$59.00	38
Micrographic Dermatologic Surgery	1,358	631	$77.89	20
Nurse Practitioner	1,144	701	$50.76	27
Otolaryngology	766	199	$55.51	1
Ophthalmology	135	94	$89.71	5
Plastic and Reconstructive Surgery	78	39	$71.70	2
General Surgery	51	24	$42.83	2
Diagnostic Radiology	33	25	$28.50	2
Hematology-Oncology	31	16	$26.68	1
Pathology	29	15	$62.57	1
Interventional Radiology	27	23	$27.97	2
Family Practice	26	12	$77.16	1
Undefined Physician type	21	13	$72.77	1

96405 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	3,368	$66.86	$51.05	77
California	2,065	$82.62	$52.48	51
Texas	1,638	$61.38	$47.53	27
Arizona	1,186	$57.87	$45.64	24
Colorado	861	$82.34	$58.01	13
North Carolina	712	$61.65	$48.40	18
Maryland	703	$76.87	$51.69	14
South Carolina	683	$59.98	$48.80	16
Virginia	633	$75.43	$54.14	13
Mississippi	443	$52.83	$45.17	5
Kansas	316	$61.04	$49.07	7
New York	290	$74.44	$49.12	9
Utah	201	$34.54	$27.20	1
Alabama	196	$64.57	$53.12	6
New Jersey	179	$80.50	$51.66	6
Michigan	174	$69.97	$51.09	7
Massachusetts	165	$76.46	$51.79	5
Georgia	133	$65.42	$54.65	4
Kentucky	133	$66.39	$51.78	3
New Hampshire	122	$63.18	$45.78	2
Tennessee	119	$63.57	$53.39	4
Washington	113	$86.11	$52.49	2
New Mexico	102	$64.33	$53.21	3
Pennsylvania	101	$54.08	$40.89	5
Oklahoma	96	$63.96	$51.66	3
Vermont	96	$66.64	$48.54	1
Rhode Island	95	$62.51	$45.77	3
Missouri	81	$72.76	$59.84	2
Illinois	67	$91.38	$55.16	2
Nevada	66	$75.10	$54.94	1
West Virginia	63	$69.93	$60.54	1
Ohio	61	$60.43	$45.65	3
Louisiana	54	$67.40	$53.44	3
Indiana	53	$64.10	$53.94	2
Wisconsin	52	$71.95	$56.57	2
Minnesota	46	$67.16	$49.28	1
Alaska	45	$81.49	$61.35	2
Arkansas	43	$69.24	$56.94	1
Oregon	40	$64.01	$51.10	1
District of Columbia	36	$76.15	$52.89	1
Connecticut	26	$75.79	$58.55	1
Hawaii	25	$25.44	$15.46	1
Iowa	11	$33.12	$26.91	1

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
96402Administration of hormonal anti-neoplastic chemotherapy under skin or$34.55
96411Administration of additional new drug or substance into vein$52.81
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.