How much does Medicare pay for CPT 96415?

Medicare allowed an average of $26.93 per service and paid $21.27 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $129.47, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96415?

Administration of chemotherapy into vein, each additional hour. It was billed 544,416 times to 134,260 Medicare beneficiaries by 4,837 providers in 2024.

Which specialty bills 96415 most?

Hematology-Oncology, with 221,467 services from 1,935 clinicians. Next are Rheumatology, Medical Oncology, Nurse Practitioner.

CPT 96415

Administration of chemotherapy into vein, each additional hour

$26.93Medicare-allowed amount per service, averaged across 544,416 services

Providers submitted

$129.47

Asking price, not received

Medicare allowed

$26.93

The fee schedule figure

Medicare paid

$21.27

Balance is patient coinsurance

Providers submitted an average of $129.47 for this code and Medicare allowed $26.93 — 4.8× 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 $21.27 (79%); the rest is the patient’s coinsurance and deductible.

Services: 544,416
Beneficiaries: 134,260
Providers billing it: 4,837
Total allowed: $14,661,123

What Medicare pays for CPT 96415

Across 544,416 services billed by 4,837 providers to 134,260 beneficiaries, Medicare allowed an average of $26.93 per service. That is 4.1 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 96415

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	221,467	55,349	$27.21	1,935
Rheumatology	170,122	34,683	$27.17	1,093
Medical Oncology	61,479	17,224	$27.17	644
Nurse Practitioner	26,738	8,742	$22.24	387
Internal Medicine	18,610	4,875	$27.34	182
Neurology	9,010	2,528	$26.87	109
Gastroenterology	6,073	3,015	$26.12	178
Hematology	5,936	1,455	$28.65	47
Gynecological Oncology	5,162	1,034	$26.47	47
Family Practice	4,221	894	$26.88	26
Physician Assistant	4,167	1,491	$22.86	66
Infectious Disease	2,816	786	$25.91	36
Nephrology	1,615	413	$30.46	9
Pediatric Medicine	1,075	133	$28.10	6
Hospitalist	911	215	$29.97	8

96415 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	61,476	$26.49	$21.25	502
California	56,654	$30.67	$21.30	407
Texas	54,851	$25.94	$21.22	543
Illinois	24,137	$27.00	$21.36	237
New York	23,660	$29.27	$21.30	219
Virginia	20,296	$27.37	$21.37	175
Arizona	19,848	$26.83	$21.28	165
New Jersey	19,703	$30.05	$21.42	130
Maryland	19,402	$29.17	$21.45	150
Pennsylvania	17,370	$27.62	$21.39	185
North Carolina	15,263	$25.18	$20.98	174
Tennessee	13,890	$24.13	$20.98	150
South Carolina	13,458	$24.54	$20.83	104
Ohio	11,937	$25.14	$21.15	127
Georgia	10,635	$25.25	$21.41	89
Colorado	10,506	$27.96	$21.13	111
Arkansas	10,104	$23.76	$21.25	69
Kansas	10,043	$24.65	$21.02	44
Michigan	9,284	$25.52	$20.89	105
Alabama	8,929	$24.18	$21.44	81
Minnesota	8,894	$27.45	$21.32	133
Missouri	8,864	$25.39	$21.12	87
Oklahoma	7,654	$23.55	$20.74	50
Oregon	7,481	$27.05	$21.32	69
Indiana	7,077	$25.01	$21.24	64
Washington	6,997	$28.10	$21.36	70
Iowa	6,492	$24.98	$21.46	55
Nevada	6,415	$26.83	$21.34	46
Massachusetts	5,937	$29.28	$21.19	49
Mississippi	5,743	$23.99	$21.19	46
Wisconsin	5,433	$25.31	$21.28	52
Nebraska	4,812	$25.01	$21.41	61
New Mexico	3,791	$25.38	$21.44	37
Utah	3,641	$25.43	$21.15	37
Kentucky	3,206	$23.93	$20.84	27
Louisiana	3,092	$24.55	$21.21	28
Delaware	2,885	$27.19	$21.03	21
Idaho	2,231	$24.65	$20.81	13
Alaska	1,955	$30.68	$20.80	19
Connecticut	1,766	$28.53	$20.71	25
South Dakota	1,459	$26.71	$20.84	10
Wyoming	936	$27.10	$21.25	4
Maine	918	$26.53	$20.76	13
New Hampshire	814	$27.65	$20.65	12
Puerto Rico	682	$24.86	$20.45	2
North Dakota	589	$26.20	$19.46	4
West Virginia	492	$25.95	$21.09	6
Vermont	490	$27.86	$21.56	4
Rhode Island	479	$28.03	$21.42	9
District of Columbia	445	$31.13	$21.47	6
Montana	436	$26.17	$20.87	4
U.S. Virgin Islands	276	$27.85	$21.40	1
Guam	247	$29.55	$21.49	2
Hawaii	221	$29.61	$21.62	3
XX	120	$26.19	$21.24	1

Related codes

96413Administration of chemotherapy into vein$125.25
96401Administration of non-hormonal anti-neoplastic chemotherapy under skin$70.79
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.