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CPT® Code 96406 refers to the administration of chemotherapy through intralesional injection, specifically when more than seven malignant lesions are treated. This procedure involves the injection of an anti-neoplastic agent directly into one or more malignant lesions located in the skin or subcutaneous tissues. The primary goal of this treatment is to eradicate or significantly reduce the size of these lesions. Prior to the injection, the physician ensures that the skin surrounding the planned injection site is thoroughly cleansed to minimize the risk of infection. Following this preparation, the physician proceeds to inject the anti-neoplastic agent into and around each lesion. If multiple lesions are present, the injection process is repeated for each lesion until all targeted areas have received the treatment. It is important to note that the coding for this procedure is based on the total number of lesions treated rather than the number of injections performed, as a single lesion may require multiple injection sites. For cases involving up to seven lesions, CPT® Code 96405 should be utilized, while CPT® Code 96406 is specifically designated for instances where more than seven lesions are injected.
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The procedure associated with CPT® Code 96406 is indicated for the treatment of malignant lesions in the skin or subcutaneous tissues. The following conditions may warrant the use of this procedure:
The procedure for administering chemotherapy via CPT® Code 96406 involves several critical steps to ensure effective treatment of the malignant lesions. The following outlines the procedural steps:
After the completion of the intralesional chemotherapy injections, the physician may provide specific post-procedure care instructions to the patient. This may include monitoring the injection sites for any signs of adverse reactions, such as swelling, redness, or infection. Patients are typically advised to avoid strenuous activities that could irritate the injection sites and to follow up with their healthcare provider for any necessary evaluations or additional treatments. The expected recovery time may vary depending on the individual patient's response to the chemotherapy and the extent of the lesions treated.
| Short Descr | CHEMO INTRALESIONAL OVER 7 | Medium Descr | CHEMOTHERAPY ADMINISTRATION INTRALESIONAL >7 | Long Descr | Chemotherapy administration; intralesional, more than 7 lesions | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 1 - Statutory 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 | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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. | 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.) | CR | Catastrophe/disaster related | KX | Requirements specified in the medical policy have been met | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2006-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |