Not as two initial codes. A chemotherapy infusion on the encounter is the initial service (96413), and each chemotherapy drug pushed through the same access is 96411 (each additional substance). 96409 with 96413 is for a separate IV site (XS) or a separate encounter (XE); the 96413 / 96409 edit has been in place since 2006.
The 96409 / 96413 pair as it stands in the CMS PTP tables for 2026q3 (as of 2026-07-01), identical on the practitioner and hospital-outpatient tables:
96409 (column 2) denies as included in 96413 (column 1) unless the 96409 line carries a distinct-service modifier — XS for a separate access site, XE for a separate encounter, or 59 — and the record supports a distinct service.
Column 1 96413 · column 2 96409 · edit effective January 2006.
Same edit, same direction: column 1 96413, column 2 96409, since January 2006. A UB-04 carrying 96413 and 96409 is adjudicated exactly as the CMS-1500 is.
Regimens that combine pushed and infused agents — ABVD, CHOP, FOLFOX bolus doses — put this pair on almost every treatment day. Both routes are chemotherapy administration, so the question is never whether the pushes are billable but which code carries them. One initial chemotherapy service per encounter: in physician reporting it is the primary reason for the visit, and in facility reporting CPT ranks infusion above push — both make 96413 the initial, and each pushed chemotherapy drug is a unit of 96411, up to the practitioner MUE of 3 per date of service.
The 96413 / 96409 PTP edit (column 2 = 96409, modifier indicator 1) is the oldest on these pages, effective January 2006. It denies 96409 as included in 96413 unless the push was genuinely a second initial service: a separate IV access started because the pushed drug was incompatible with the infusion line, or a distinct encounter on the same date. Then, and only then, 96409 carries XS or XE (59 where the payer has not adopted the X modifiers) beside 96413.
Waste modifiers travel with the drug lines, not the administration: every vial in the worked claim was fully used, so dacarbazine, doxorubicin and bleomycin each carry JZ; a partially used single-dose vial would add a JW line for the discarded amount without touching the administration codes. The 96411 units are counted by substance — doxorubicin and bleomycin make two — and a second push of the same drug at one sitting does not add a unit in the office. Vinblastine, the fourth ABVD agent given the same day, is a third 96411 unit; it is left out of this example only to keep the vial arithmetic to three drugs.
A second IV access site because the pushed chemotherapy could not share the infusion line, or a second encounter on the date. Then 96409-XS or 96409-XE with 96413 is correct. Pushing through the Y-site or the saline lock of the running infusion is sequential and is 96411.
| Code | Descriptor | Practitioner MUE / day | Facility MUE / day | Adjudication · rationale |
|---|---|---|---|---|
96409 | chemotherapy IV push, single or initial drug | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96413 | chemotherapy or highly complex biologic IV infusion, initial hour | 1 | 1 | MAI 3 · Code Descriptor / CPT Instruction |
96409 and 96413 are MAI 3: units are summed across the date of service, and a documented medical-necessity appeal can pay units above the limit. Other codes: MUE lookup.
The 96409 / 96413 answer rests on H1 in the claim builder’s rule set (source: NCCI Policy Manual 2026 ch. XI §B.2), the rule it applies when it places the initial-service line:
…For a patient encounter, only one "initial" service code may be reported unless it is medically reasonable and necessary that the drug or substance administrations occur at separate intravenous access sites.… Full text of H1
Related hierarchy rules for this claim: H5 (CPT 2026 hydration / therapeutic infusion guidelines) and H10 (CPT 2026 hydration / therapeutic infusion guidelines · CMS Pub 100-04 ch. 12 §30.5).
CO-97 on 96409 with 96413. Rebill the pushed agents as 96411 units (one per substance) when they went through the same access on one encounter; use 96409-XS or 96409-XE only for a documented separate site or encounter.
The median payer contract pays 136–140% of Medicare on 96409, 96413, 96411. On 96409 the highest payer median is Blue Shield of California’s $500.18 and the lowest BCBS Arizona’s $74.46, against Medicare’s $104.54; Blue Shield of California is highest on 3 of the 3 lines. Pick a state below for each payer’s own number where you bill.
| Code | Medicare (PFS, office) | Median payer contract | Middle half of payer medians | Payers |
|---|---|---|---|---|
96409 | $104.54 | $142.05 (136%) | $130.50–$170.61 | 37 |
96413 | $133.27 | $187.00 (140%) | $170.46–$217.49 | 36 |
96411 | $57.12 | $79.20 (139%) | $73.50–$93.52 | 37 |
5,212 payer×state medians for 96409, 96413, 96411 from 37 payers’ Transparency-in-Coverage files (2026-Q2-06); Medicare = national non-facility PFS.
This claim priced by your payer — Dacarbazine’s rate on the drug line, 96409 and 96413 and 96411 at the payer’s contracted amount, the payer’s policy on Dacarbazine (prior auth, covered diagnoses), and the patient’s share — is the same claim in your free account.
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96413 counts. 96411 is an add-on to the encounter’s initial chemotherapy service, and CPT lists both 96409 and 96413 as acceptable primaries. On a day with an infusion, 96413 is the initial and 96411 hangs off it; 96409 does not appear.
Oxaliplatin over two hours is 96413 plus 96415 × 1; the 5-FU bolus push is 96411; the pump initiation is 96416, which has no edit against 96413 or 96411. No 96409, because the infusion is the encounter’s initial service.
No: 96411 is for chemotherapy substances. A non-chemo drug pushed during a chemotherapy encounter is 96375 (each additional sequential new drug, non-chemo), reported alongside 96413 with no edit and no modifier.