How much does Medicare pay for CPT 96416?

Medicare allowed an average of $130.62 per service and paid $104.03 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $532.57, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96416?

Administration of prolonged chemotherapy into vein. It was billed 7,574 times to 2,208 Medicare beneficiaries by 119 providers in 2024.

Which specialty bills 96416 most?

Hematology-Oncology, with 5,185 services from 82 clinicians. Next are Medical Oncology, Infectious Disease, Hematology.

CPT 96416

Administration of prolonged chemotherapy into vein

$130.62Medicare-allowed amount per service, averaged across 7,574 services

Providers submitted

$532.57

Asking price, not received

Medicare allowed

$130.62

The fee schedule figure

Medicare paid

$104.03

Balance is patient coinsurance

Providers submitted an average of $532.57 for this code and Medicare allowed $130.62 — 4.1× 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 $104.03 (80%); the rest is the patient’s coinsurance and deductible.

Services: 7,574
Beneficiaries: 2,208
Providers billing it: 119
Total allowed: $989,316

What Medicare pays for CPT 96416

Across 7,574 services billed by 119 providers to 2,208 beneficiaries, Medicare allowed an average of $130.62 per service. That is 3.4 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 96416

Specialty	Services	Beneficiaries	Avg allowed	Providers
Hematology-Oncology	5,185	1,427	$130.45	82
Medical Oncology	1,759	456	$132.68	27
Infectious Disease	267	184	$126.76	1
Hematology	213	69	$126.93	4
Internal Medicine	137	61	$122.38	4
Surgical Oncology	13	11	$146.89	1

96416 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	2,203	$147.43	$98.92	37
Nebraska	734	$115.25	$99.23	7
South Carolina	663	$115.14	$98.31	10
New York	607	$151.36	$99.47	5
Maryland	474	$129.27	$99.40	9
Michigan	403	$120.23	$98.20	8
Georgia	371	$105.87	$100.86	7
New Jersey	363	$141.47	$98.91	5
Florida	313	$125.66	$99.46	2
Pennsylvania	306	$125.71	$98.82	4
New Mexico	169	$110.73	$99.46	4
Arkansas	167	$109.30	$99.43	5
Ohio	155	$123.31	$98.54	3
Texas	143	$124.95	$98.63	2
Illinois	113	$128.52	$99.65	3
Utah	103	$116.82	$99.39	1
Louisiana	57	$111.18	$99.60	1
Alabama	48	$112.08	$99.51	1
Minnesota	47	$115.30	$101.40	1
North Carolina	46	$114.25	$99.36	1
Nevada	46	$124.72	$99.65	1
Missouri	23	$108.71	$99.68	1
Virginia	20	$121.02	$98.30	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
96409Administration of chemotherapy into vein$99.73
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.