How much does Medicare pay for CPT 96413?

Medicare allowed an average of $125.25 per service and paid $98.29 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $481.74, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96413?

Administration of chemotherapy into vein, 1 hour or less. It was billed 1,637,325 times to 449,467 Medicare beneficiaries by 7,637 providers in 2024.

Which specialty bills 96413 most?

Hematology-Oncology, with 740,501 services from 2,609 clinicians. Next are Rheumatology, Medical Oncology, Nurse Practitioner.

CPT 96413

Administration of chemotherapy into vein, 1 hour or less

$125.25Medicare-allowed amount per service, averaged across 1,637,325 services

Providers submitted

$481.74

Asking price, not received

Medicare allowed

$125.25

The fee schedule figure

Medicare paid

$98.29

Balance is patient coinsurance

Providers submitted an average of $481.74 for this code and Medicare allowed $125.25 — 3.8× 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 $98.29 (78%); the rest is the patient’s coinsurance and deductible.

Services: 1,637,325
Beneficiaries: 449,467
Providers billing it: 7,637
Total allowed: $205,074,956

What Medicare pays for CPT 96413

Across 1,637,325 services billed by 7,637 providers to 449,467 beneficiaries, Medicare allowed an average of $125.25 per service. That is 3.6 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 96413

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	740,501	192,294	$126.80	2,609
Rheumatology	419,778	102,243	$126.40	1,561
Medical Oncology	213,989	63,668	$125.83	863
Nurse Practitioner	81,232	31,486	$105.00	951
Internal Medicine	60,532	17,960	$126.38	328
Neurology	27,661	6,763	$124.00	215
Hematology	19,115	5,034	$132.31	89
Gastroenterology	17,465	9,180	$123.48	466
Physician Assistant	14,236	6,195	$107.14	177
Gynecological Oncology	11,293	2,896	$123.75	71
Infectious Disease	6,626	2,420	$123.95	77
Family Practice	4,681	1,823	$120.11	49
Hospitalist	3,347	914	$139.51	12
Radiation Oncology	2,402	1,160	$123.19	42
Allergy/ Immunology	2,001	656	$127.57	16

96413 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	204,769	$122.77	$98.45	756
Texas	167,626	$121.06	$98.74	836
California	143,501	$149.03	$98.52	648
Illinois	72,663	$124.58	$98.84	389
Virginia	66,605	$127.59	$98.61	245
Maryland	61,825	$138.09	$99.26	244
Arizona	61,661	$124.65	$98.66	234
New York	59,828	$137.60	$98.65	353
New Jersey	53,810	$142.83	$98.63	227
Pennsylvania	53,174	$128.86	$99.18	280
Tennessee	52,460	$111.65	$97.78	262
North Carolina	45,395	$117.49	$98.32	279
South Carolina	43,302	$116.01	$98.63	152
Georgia	39,881	$116.67	$99.62	159
Ohio	39,635	$116.10	$98.16	209
Arkansas	35,319	$109.18	$98.92	79
Alabama	33,900	$110.19	$99.45	167
Michigan	28,754	$119.59	$97.72	177
Minnesota	28,521	$128.86	$98.53	259
Colorado	27,999	$131.06	$97.48	159
Missouri	24,747	$117.03	$97.30	142
Iowa	23,073	$115.34	$99.41	94
Indiana	21,721	$114.68	$98.20	112
Kansas	21,268	$113.97	$97.49	49
Washington	19,603	$131.65	$97.72	134
Oklahoma	18,749	$109.60	$97.52	67
Mississippi	18,207	$109.57	$97.32	62
Nevada	17,223	$126.05	$98.55	72
Louisiana	16,781	$112.55	$99.51	64
Nebraska	16,513	$114.65	$98.09	92
Oregon	16,504	$128.19	$98.16	81
Wisconsin	11,778	$117.56	$97.15	79
Massachusetts	11,083	$135.70	$97.65	66
Kentucky	10,481	$110.19	$96.82	51
Delaware	8,937	$127.78	$97.60	24
Utah	8,748	$115.75	$98.33	58
New Mexico	8,185	$116.69	$99.46	51
Connecticut	6,980	$136.66	$97.05	51
Idaho	6,212	$113.10	$97.03	18
Alaska	5,831	$135.82	$96.15	21
Maine	5,156	$125.90	$97.08	24
New Hampshire	3,391	$130.15	$95.83	16
South Dakota	2,197	$125.12	$98.22	10
District of Columbia	2,095	$146.39	$99.14	25
Wyoming	2,000	$128.01	$97.06	8
North Dakota	1,837	$124.04	$92.24	6
Vermont	1,604	$130.49	$99.58	4
West Virginia	1,526	$116.76	$98.12	11
Rhode Island	1,358	$132.17	$98.26	12
Hawaii	918	$139.00	$100.18	6
U.S. Virgin Islands	556	$127.55	$100.00	2
Guam	441	$140.98	$99.67	3
Montana	387	$115.43	$95.26	4
Puerto Rico	317	$110.15	$95.53	3
XX	290	$120.83	$98.74	1

Related codes

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
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.