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The CPT® Code 96415 refers to the administration of chemotherapy through an intravenous infusion technique, specifically for each additional hour beyond the initial hour of treatment. This procedure is crucial in the management of malignant neoplasms, where chemotherapy agents are delivered directly into the bloodstream to target cancer cells. The process begins with the placement of an intravenous line, typically in a patient's arm, allowing for the direct infusion of the specified chemotherapy drug. During this administration, the physician plays a vital role by providing direct supervision, ensuring that they are readily available to address any complications that may arise during the infusion. Furthermore, the physician conducts periodic assessments of the patient’s condition and meticulously documents the patient's response to the chemotherapy treatment. It is important to note that this code is used in conjunction with other related codes: CPT® Code 96413 is utilized for the initial hour of chemotherapy infusion, while CPT® Code 96416 is designated for prolonged infusions exceeding eight hours that require specialized equipment, such as a portable or implantable pump. Additionally, CPT® Code 96417 is applicable for any additional sequential infusion of a different chemotherapy substance or drug for a duration of up to one hour. This structured approach to chemotherapy administration ensures that patients receive the necessary treatment while closely monitoring their health and response to the drugs administered.
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The procedure associated with CPT® Code 96415 is indicated for the administration of chemotherapy agents in the treatment of malignant neoplasms. This includes various types of cancer where chemotherapy is deemed necessary to manage the disease effectively. The specific indications for this procedure may include, but are not limited to, the following:
The procedure for CPT® Code 96415 involves several key steps that ensure the safe and effective administration of chemotherapy. Each step is critical to the overall process of delivering treatment to the patient.
Following the administration of chemotherapy using CPT® Code 96415, patients are typically monitored for any immediate reactions to the treatment. It is essential to observe for signs of adverse effects, which may include nausea, vomiting, allergic reactions, or other complications. Patients may be advised to rest and hydrate adequately after the procedure. Additionally, they should be informed about potential delayed side effects that may occur in the days following the infusion, such as fatigue, changes in appetite, or increased susceptibility to infections. Clear instructions regarding follow-up appointments and any necessary laboratory tests to monitor the patient's response to treatment are also provided. This comprehensive post-procedure care is vital for ensuring patient safety and optimizing treatment outcomes.
| Short Descr | CHEMO IV INFUSION ADDL HR | Medium Descr | CHEMOTHERAPY ADMN IV INFUSION TQ EA HR | Long Descr | Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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 | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P7B - Oncology - other | MUE | 8 | CCS Clinical Classification | 224 - Cancer chemotherapy |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 96413 | MPFS Status: Active Code APC S Physician Quality Reporting PUB 100 CPT Assistant Article Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | 0663T | Add-on Code MPFS Status: Carrier Priced APC N Scalp cooling, mechanical; placement of device, monitoring, and removal of device (List separately in addition to code for primary procedure) | 96368 | Addon Code MPFS Status: Active Code APC N CPT Assistant Article Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) |
| 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. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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. | KX | Requirements specified in the medical policy have been met | 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 | RT | Right side (used to identify procedures performed on the right side of the body) | CR | Catastrophe/disaster related | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | JZ | Zero drug amount discarded/not administered to any patient | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | 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 | 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. | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CG | Policy criteria applied | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GX | Notice of liability issued, voluntary under payer policy | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | JW | Drug amount discarded/not administered to any patient | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | SA | Nurse practitioner rendering service in collaboration with a physician | SU | Procedure performed in physician's office (to denote use of facility and equipment) | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Changed | Code description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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