© Copyright 2025 American Medical Association. All rights reserved.
CPT® Code 96417 refers to the administration of chemotherapy through an intravenous infusion technique, specifically for each additional sequential infusion of a different substance or drug, lasting up to one hour. This procedure is typically performed in the context of treating malignant neoplasms, where a healthcare provider administers chemotherapy agents to combat cancer. The process involves placing an intravenous line into a patient's vein, commonly in the arm, to facilitate the delivery of the chemotherapy agent. During this administration, the physician is responsible for providing direct supervision, ensuring that they are readily available to address any complications that may arise during the infusion. Additionally, the physician conducts periodic assessments of the patient's condition and documents their response to the treatment, which is crucial for monitoring effectiveness and managing any side effects. It is important to note that this code is used in conjunction with other related codes, such as CPT® 96413 for the initial infusion of a single chemotherapy substance or drug, and CPT® 96415 for each additional hour of the same substance or drug. Furthermore, CPT® 96416 is designated for prolonged infusions exceeding eight hours that require specialized equipment, while CPT® 96417 specifically addresses the need for additional infusions of different chemotherapy agents within the same treatment session.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure associated with CPT® Code 96417 is indicated for the administration of chemotherapy agents in the treatment of malignant neoplasms. This includes patients who require multiple chemotherapy substances or drugs as part of their cancer treatment regimen. The use of this code is appropriate when a patient is receiving sequential infusions of different chemotherapy agents, necessitating the need for additional intravenous infusions beyond the initial administration.
The procedure for CPT® Code 96417 involves several key steps to ensure the safe and effective administration of chemotherapy. First, the healthcare provider prepares the necessary equipment, including the chemotherapy agent, intravenous (IV) line, and infusion pump if required. The patient is then positioned comfortably, and an IV line is inserted into a suitable vein, typically in the arm. Once the IV line is established, the healthcare provider connects the chemotherapy agent to the IV line and begins the infusion. Throughout the infusion process, the physician or qualified healthcare professional closely monitors the patient for any adverse reactions or complications. This includes assessing vital signs and observing the patient’s overall condition. The infusion is administered for a duration of up to one hour, during which the physician remains available to intervene if necessary. After the infusion is complete, the healthcare provider ensures that the IV line is properly removed and that the patient is stable before concluding the procedure. Documentation of the infusion, including the type of chemotherapy agent used and the patient's response, is also completed to maintain accurate medical records.
Post-procedure care following the administration of chemotherapy using CPT® Code 96417 involves monitoring the patient for any immediate side effects or complications that may arise from the infusion. Patients are typically observed for a period to ensure they are stable and do not exhibit any adverse reactions. It is essential for healthcare providers to provide instructions regarding potential side effects that may occur after the infusion, such as nausea, fatigue, or allergic reactions. Patients may also be advised on hydration and dietary considerations to support recovery. Follow-up appointments may be scheduled to assess the patient's response to the chemotherapy treatment and to plan for any subsequent infusions if necessary. Documentation of the patient's condition and any post-infusion instructions given is crucial for continuity of care.
| Short Descr | CHEMO IV INFUS EACH ADDL SEQ | Medium Descr | CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR | Long Descr | Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 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) | P6C - Minor procedures - other (Medicare fee schedule) | MUE | 3 | 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) |
| 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 | 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 | 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 | CR | Catastrophe/disaster related | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | KX | Requirements specified in the medical policy have been met | GW | Service not related to the hospice patient's terminal condition | 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. | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 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). | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | 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 | SA | Nurse practitioner rendering service in collaboration with a physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2006-01-01 | Added | First appearance in code book in 2006. |
Get instant expert-level medical coding assistance.