{
    "code": "96413",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/96413/2019/A",
    "release_specific_url": "https://localishealth.com/cpt/96413/2019/C",
    "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 Q3 2019?",
        "text": "Medicare paid $143.08 for CPT 96413 in the office (non-facility) setting and $143.08 in a facility under the Q3 2019 Physician Fee Schedule, effective July 2019. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2019, when it decreased 1.1%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2019,
        "quarter": "C",
        "label": "Q3 2019",
        "effective": "July 1 – September 30, 2019",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 143.08,
        "facility": 143.08,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.28,
        "practice_expense_non_facility": 3.61,
        "practice_expense_facility": 3.61,
        "malpractice": 0.08
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 36.0391,
    "source": {
        "label": "Physician relative value file (Q3 2019)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu19c.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2019/C",
        "file": "PPRRVU19_JUL.csv",
        "row": 16658,
        "sha256": "2ea00e3e75fc3a53497bb8eb3c7d29a58404efd9449993daa6f80791a770b47a"
    },
    "modified_at": "2026-08-04T03:09:02+00:00"
}