{
    "code": "96413",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/96413/2016/A",
    "release_specific_url": "https://localishealth.com/cpt/96413/2016/D",
    "description": "Intravenous infusion of a chemotherapy drug — or another agent complex enough to need the same level of monitoring — covering the first hour of the drip. The work bundled here is the whole nursing episode: preparing the agent, starting and running the line, watching the patient for reactions while it goes in, and flushing at the end. This is the opening code for an infusion visit; a drip that runs well past an hour, or a second agent given the same day, is captured by separate companion codes.",
    "answer": {
        "question": "How much did Medicare pay for CPT 96413 in Q4 2016?",
        "text": "Medicare paid $136.41 for CPT 96413 in the office (non-facility) setting and $136.41 in a facility under the Q4 2016 Physician Fee Schedule, effective October 2016. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2016, when it decreased 0.1%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2016,
        "quarter": "D",
        "label": "Q4 2016",
        "effective": "October 1 – December 31, 2016",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 136.41,
        "facility": 136.41,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.28,
        "practice_expense_non_facility": 3.45,
        "practice_expense_facility": 3.45,
        "malpractice": 0.08
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 35.8043,
    "source": {
        "label": "Physician relative value file (Q4 2016)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu16d.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2016/D",
        "file": "PPRRVU16_V0804.csv",
        "row": 16002,
        "sha256": "376b12d2df1b1c1abaed1e123e9501352bf559c75a0a4f87f52878742af491c9"
    },
    "modified_at": "2026-08-04T03:07:13+00:00"
}