© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 96416 refers to the administration of chemotherapy through an intravenous infusion technique, specifically for the initiation of a prolonged chemotherapy infusion that lasts more than eight hours. This procedure necessitates the use of a portable or implantable pump to deliver the chemotherapy agent effectively. In this context, chemotherapy is a treatment method that utilizes specific drugs to target and destroy malignant neoplasms, which are cancerous tumors. The administration process involves placing an intravenous line into a vein, typically located in the patient's arm, through which the chemotherapy substance is infused. During this procedure, the physician plays a critical role by providing direct supervision, ensuring that they are immediately available to address any complications that may arise during the infusion. Additionally, the physician is responsible for conducting periodic assessments of the patient's condition and documenting their response to the treatment, which is essential for monitoring the effectiveness of the chemotherapy and making any necessary adjustments to the treatment plan. For shorter infusions, such as those lasting up to one hour, the appropriate code is 96413, while for each additional hour of infusion, the add-on code 96415 should be used. In cases where an additional sequential infusion of a different chemotherapy substance or drug is required for up to one hour, the add-on code 96417 is applicable.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 96416 is indicated for the treatment of patients with malignant neoplasms, which are cancerous tumors that require prolonged chemotherapy administration. This method is particularly relevant for patients whose treatment plans necessitate extended infusion times exceeding eight hours, allowing for a more sustained delivery of chemotherapy agents. The use of a portable or implantable pump is essential in these cases to ensure the continuous and controlled administration of the chemotherapy substance, thereby optimizing therapeutic outcomes while minimizing potential side effects.
The procedure for CPT® Code 96416 involves several critical steps to ensure the safe and effective administration of chemotherapy. First, the healthcare provider prepares the chemotherapy agent, ensuring that it is correctly dosed and ready for infusion. Next, an intravenous line is established by inserting a catheter into a suitable vein, typically in the patient's arm. This line serves as the conduit for the chemotherapy substance. Once the intravenous line is in place, the physician initiates the infusion using a portable or implantable pump, which is designed to deliver the chemotherapy agent over an extended period, specifically more than eight hours. Throughout the infusion process, the physician maintains direct supervision, remaining immediately available to address any complications that may arise. Periodic assessments of the patient's condition are conducted to monitor their response to the treatment, and thorough documentation is maintained to record any changes in the patient's status or side effects experienced during the infusion.
After the completion of the prolonged chemotherapy infusion, the patient may require specific post-procedure care to monitor for any immediate side effects or complications resulting from the treatment. The healthcare provider should assess the patient's vital signs and overall condition to ensure stability. Patients may experience various side effects, including nausea, fatigue, or localized reactions at the infusion site, which should be documented and managed accordingly. Follow-up appointments may be scheduled to evaluate the patient's response to the chemotherapy and to determine the need for further treatment. Additionally, the healthcare team should provide the patient with information regarding potential delayed side effects and instructions on when to seek medical attention if any concerning symptoms arise after the procedure.
| Short Descr | CHEMO PROLONG INFUSE W/PUMP | Medium Descr | CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP | Long Descr | Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump | 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 | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 1 | CCS Clinical Classification | 224 - Cancer chemotherapy |
This is a primary code that can be used with these additional add-on codes.
| 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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 | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | JW | Drug amount discarded/not administered to any patient | 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 | 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 | SA | Nurse practitioner rendering service in collaboration with a physician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2006-01-01 | Added | First appearance in code book in 2006. |
Get instant expert-level medical coding assistance.