How much does Medicare pay for CPT 96450?

Medicare allowed an average of $71.36 per service and paid $55.81 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $787.06, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 96450?

Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord. It was billed 1,187 times to 683 Medicare beneficiaries by 41 providers in 2024.

Does 96450 pay differently in an office than a hospital?

Yes. The allowed amount averaged $63.32 in an office setting and $71.54 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 96450 most?

Diagnostic Radiology, with 618 services from 21 clinicians. Next are Physician Assistant, Nurse Practitioner, Pain Management.

CPT 96450

Administration of chemotherapy into fluid-filled space between the tissue that cover the brain and spinal cord

$71.36Medicare-allowed amount per service, averaged across 1,187 services

Providers submitted

$787.06

Asking price, not received

Medicare allowed

$71.36

The fee schedule figure

Medicare paid

$55.81

Balance is patient coinsurance

Providers submitted an average of $787.06 for this code and Medicare allowed $71.36 — 11.0× 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 $55.81 (78%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $63.32
Hospital / facility: $71.54

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 26 services were billed in an office setting and 1,161 in a facility.

Services: 1,187
Beneficiaries: 683
Providers billing it: 41
Total allowed: $84,704

What Medicare pays for CPT 96450

Across 1,187 services billed by 41 providers to 683 beneficiaries, Medicare allowed an average of $71.36 per service. That is 1.7 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 96450

Specialty	Services	Beneficiaries	Avg allowed	Providers
Diagnostic Radiology	618	359	$76.29	21
Physician Assistant	301	161	$63.72	9
Nurse Practitioner	170	121	$61.85	8
Pain Management	57	28	$84.34	2
Anesthesiology	41	14	$74.34	1

96450 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	268	$68.17	$51.69	9
California	184	$79.71	$57.12	6
New York	161	$79.56	$57.01	7
Kansas	138	$71.01	$57.37	2
Minnesota	111	$64.50	$51.25	3
Texas	79	$64.93	$49.62	4
Pennsylvania	67	$68.14	$54.90	3
Colorado	53	$71.80	$55.33	2
Virginia	50	$61.69	$48.83	1
Tennessee	43	$71.46	$57.60	2
Illinois	19	$69.14	$44.55	1
Missouri	14	$73.07	$58.99	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
96416Administration of prolonged chemotherapy into vein$130.62

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.