© Copyright 2025 American Medical Association. All rights reserved.
CPT® Code 96402 refers to the administration of chemotherapy through subcutaneous or intramuscular routes specifically for hormonal anti-neoplastic agents. This procedure involves the delivery of medication designed to treat cancer by inhibiting the growth of hormone-sensitive tumors. The administration can occur via a subcutaneous injection, which is performed just beneath the skin in areas such as the abdomen, upper arm, upper leg, or buttocks. The process begins with cleansing the skin to minimize the risk of infection. A fold of skin is pinched to create a suitable injection site, and the needle is inserted at an angle ranging from 45 to 90 degrees, depending on the specific technique used. In cases where an intramuscular injection is indicated, the needle is inserted deeper into the muscle tissue, typically at a 90-degree angle, allowing for rapid systemic absorption of the medication. Common sites for intramuscular injections include the gluteal muscles of the buttocks, the vastus lateralis muscle of the thigh, or the deltoid muscle of the upper arm. This method is particularly useful for administering larger doses of chemotherapy agents. It is important to note that CPT® Code 96402 is specifically designated for hormonal anti-neoplastic agents, while CPT® Code 96401 is used for non-hormonal anti-neoplastic agents. This distinction is crucial for accurate coding and billing in medical practices.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 96402 is indicated for the administration of hormonal anti-neoplastic agents in the treatment of various hormone-sensitive cancers. The following conditions may warrant the use of this procedure:
The procedure for administering hormonal anti-neoplastic agents via CPT® Code 96402 involves several key steps, whether performed subcutaneously or intramuscularly. Each step is critical to ensure the safe and effective delivery of the medication.
After the administration of hormonal anti-neoplastic agents via CPT® Code 96402, patients may be monitored for any immediate adverse reactions to the medication. It is essential to observe the injection site for signs of infection, such as redness, swelling, or discharge. Patients may also be advised to avoid strenuous activities at the injection site for a short period to allow for proper healing. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to manage any potential side effects associated with hormonal therapy. Documentation of the procedure, including the medication administered, dosage, and any patient reactions, is crucial for compliance and billing purposes.
| Short Descr | CHEMO HORMON ANTINEOPL SQ/IM | Medium Descr | CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO | Long Descr | Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 5 - Incident To Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 2 | CCS Clinical Classification | 224 - Cancer chemotherapy |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | RT | Right side (used to identify procedures performed on the right side of the body) | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | LT | Left side (used to identify procedures performed on the left side of the body) | JZ | Zero drug amount discarded/not administered to any patient | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | GW | Service not related to the hospice patient's terminal condition | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | KX | Requirements specified in the medical policy have been met | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | CR | Catastrophe/disaster related | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 56 | Preoperative management only: when 1 physician or other qualified health care professional performed the preoperative care and evaluation and another performed the surgical procedure, the preoperative component may be identified by adding modifier 56 to the usual procedure number. | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | JB | Administered subcutaneously | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q5 | Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | TT | Individualized service provided to more than one patient in same setting | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2006-01-01 | Added | First appearance in code book in 2006. |
Get instant expert-level medical coding assistance.