How much does Medicare pay for CPT 96409?

Medicare allowed an average of $99.73 per service and paid $78.34 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $414.17, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96409?

Administration of chemotherapy into vein using push technique. It was billed 8,016 times to 2,589 Medicare beneficiaries by 180 providers in 2024.

Which specialty bills 96409 most?

Hematology-Oncology, with 6,220 services from 136 clinicians. Next are Medical Oncology, Family Practice, Hematology.

CPT 96409

Administration of chemotherapy into vein using push technique

$99.73Medicare-allowed amount per service, averaged across 8,016 services

Providers submitted

$414.17

Asking price, not received

Medicare allowed

$99.73

The fee schedule figure

Medicare paid

$78.34

Balance is patient coinsurance

Providers submitted an average of $414.17 for this code and Medicare allowed $99.73 — 4.2× 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 $78.34 (79%); the rest is the patient’s coinsurance and deductible.

Services: 8,016
Beneficiaries: 2,589
Providers billing it: 180
Total allowed: $799,436

What Medicare pays for CPT 96409

Across 8,016 services billed by 180 providers to 2,589 beneficiaries, Medicare allowed an average of $99.73 per service. That is 3.1 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 96409

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	6,220	1,914	$99.62	136
Medical Oncology	1,147	441	$95.11	31
Family Practice	415	79	$115.14	1
Hematology	68	34	$89.59	3
Hematopoietic Cell Transplantation and Cellular Therapy	58	56	$95.39	4
Hospitalist	51	12	$118.38	1
Internal Medicine	25	24	$100.88	2
Rheumatology	17	17	$91.22	1
Physician Assistant	15	12	$79.62	1

96409 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
California	1,418	$117.09	$76.67	7
Florida	1,258	$95.08	$77.07	33
Arizona	496	$95.86	$75.83	27
Arkansas	381	$83.94	$76.26	13
Delaware	381	$103.40	$76.58	2
Texas	341	$94.23	$76.94	10
Georgia	339	$88.06	$77.29	7
New Jersey	338	$109.09	$76.83	4
Illinois	312	$99.02	$77.06	10
Kansas	307	$88.78	$75.77	8
Maryland	296	$106.29	$76.68	6
Iowa	277	$88.63	$77.47	4
South Carolina	259	$89.79	$75.57	7
Pennsylvania	241	$105.82	$78.15	5
Mississippi	200	$85.66	$77.44	2
New York	189	$102.71	$77.65	6
North Dakota	181	$103.26	$76.74	1
Virginia	167	$96.06	$76.12	5
Minnesota	156	$101.33	$77.76	9
Michigan	128	$90.02	$76.31	3
Washington	122	$98.91	$77.47	3
South Dakota	80	$97.30	$76.42	1
Oregon	37	$102.18	$74.02	1
Missouri	28	$94.26	$72.86	1
Colorado	25	$102.40	$74.95	1
Ohio	19	$99.69	$77.39	1
Oklahoma	17	$91.22	$70.17	1
Indiana	12	$90.10	$78.08	1
Wisconsin	11	$103.66	$77.94	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
96405Administration of chemotherapy into growth$68.35
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.