Instead of staring at different codes, learn what they actually cover to use them accurately!
Are you struggling to bill for chemotherapy administration? If you are using an intravenous infusion technique, then we might have just the code for you: CPT code 96413.
Approximately 25% of cancer patients in the U.S. receive chemotherapy. However, the delivery method for this treatment varies depending on the type and stage of the patient’s cancer. Each method has a different code. Therefore, it is no surprise that oncologists make common billing mistakes.
But don’t worry! We will decode each chemotherapy administration code one at a time. Today, let’s start with CPT code 96413.
CPT Code 96413 – Description
CPT code 96413 is a popular chemotherapy administration code. To be more specific, it refers to intravenous (IV) chemotherapy infusion. To go into more detail, healthcare providers use this code after administering a chemotherapy drug via IV, and the infusion lasts up to an hour. However, there is one condition!
You can only apply code 96413 to the single or first drug administered via IV infusion during the session. There are other codes, like 96415 and 96417, for longer infusion sessions and additional chemotherapy agents. In short, CPT code 96413 reports the one-hour-long chemotherapy infusion of the primary drug.
Scenarios Where CPT Code 96413 is Applicable
Here are three applicable scenarios for CPT 96413:
Initial Chemo Session for Breast Cancer
Did you know that about 32% of all newly diagnosed cancers in women are breast cancer each year? Chemotherapy is one of the main treatments for this disease. So, for our first example, let’s envision a 62-year-old woman with invasive ductal carcinoma, the most common form of breast cancer. It accounts for 80% of all breast cancer diagnoses.
Since her cancer is at stage III, the oncologist prescribes neoadjuvant (before surgery) chemotherapy to shrink the tumor. During the scheduled appointment, he administers an anthracycline, such as Adriamycin, for over 55 minutes in the first session. His billing team then uses CPT code 96413 to report this IV infusion.
Initial Hour-Long Chemotherapy Infusion for Prostate Cancer
Let’s consider an example of another common cancer! Prostate cancer has the second-highest mortality rate among men, right after lung cancer. While chemo is not usually the first treatment option for this type of cancer, it is often used to treat advanced stages.
Therefore, consider a 67-year-old man with advanced prostate cancer. Since cancer is no longer limited to the patient’s prostate gland, the oncologist prescribes chemotherapy along with hormone therapy. He administers docetaxel, a drug for treating metastatic cancer, via IV for up to 1 hour in the first session. The provider then uses CPT code 96413 to bill for this hour-long IV infusion.
Hour-Long Chemotherapy IV Infusion for Lung Cancer
Lung cancer is the second most common cancer in both men and women and is the leading cause of cancer deaths (around 124,730 deaths in 2025) in the U.S. The most common treatment options for this disease include surgery, chemotherapy, radiotherapy, and immunotherapy.
So, let’s assume a 47-year-old man who is diagnosed with stage II non-small cell lung cancer. Since his cancer is in mid-stage, the oncologist performs the surgery to remove the tumor and prescribes adjuvant (after surgery) chemotherapy to kill the remaining cells.
He administers anti-cancer drugs, such as cisplatin, for up to an hour in the first chemo session. His billing team reports this first chemotherapy infusion via IV with CPT code 96413.
Applicable Modifiers for CPT Code 96413
You can use the following modifiers with 96413:
Modifier 59
You can apply modifier 59 to CPT code 96413 if the chemotherapy service is unrelated to other services performed on the same day. Simply put, you can use this modifier to report two distinct services together.
However, this modifier frequently comes under payer scrutiny. Therefore, our advice is to opt for a more specific modifier to avoid audits and denials.
Modifier XE
Modifier XE is one of the better alternatives for describing the specific nature of a service. Use it with CPT code 96413 if you administered the chemotherapy drug for an hour in a separate encounter/session from other services performed on the same patient.
Modifier XP
If a different healthcare provider administered the one-hour chemotherapy infusion than the one who provided other services on the same day, append modifier XP to CPT code 96413.
CPT Code 96413 – Billing & Reimbursement Guidelines
Don’t want to risk denials and audits? Follow our clear and clean instructions for billing CPT code 96413:
Use Code 96413 for First-Hour Chemotherapy Infusion
As mentioned several times in our blog, CPT code 96413 is an initial-hour infusion code. Therefore, use it only to report the first hour of intravenous (IV) chemotherapy drug administration. You can report additional hours with an add-on code (CPT code 96415).
Use Code 96413 for Primary Drug Administration Only
Want to know another important point? CPT code 96413 only reports the first chemotherapy drug. Therefore, avoid using it to bill intravenous (IV) administration of other chemotherapy agents during the same session. There is a different code for that (CPT code 96417).
Document the Medical Necessity
The treatment should be medically necessary. In simple words, it should be crucial to treat cancer, such as lung, prostate, ovarian, or blood cancer. Therefore, mention the relevant diagnostic (ICD-10) code in the patient’s medical record. This will help justify the use of CPT code 96413.
Additionally, since this code is time-dependent, record the start and stop times of the first drug’s infusion. Also, document the drug name, dosage, and administration method (intravenous, in this case).
Bill the Chemotherapy Drug Separately
Keep one thing in mind! CPT code 96413 only covers the infusion service. To be more specific, it does not include the chemotherapy drugs. Those are billed separately using appropriate HCPCS codes starting with a capital J.
Report CPT Code 96413 Once Per Encounter
Remember the billing frequency for this code. You can report only one unit of CPT 96413 per chemotherapy session.
Verify Payer-Specific Rules & Requirements
It is common knowledge that federal and commercial payers have different policies. Therefore, always verify their coverage requirements when using CPT code 96413.
Final Word
Nail chemotherapy billing on the first try by familiarizing yourself with the most popular codes! CPT code 96413 is one of them. But heads up, it only reports the intravenous (IV) infusion of the first drug during the first hour. To summarize the key points, healthcare providers can use this code only once per chemo session.
The most important part? Code 96413 does not include the drug itself. In short, you must bill that separately using an appropriate HCPCS code.
We hope you are now familiar with all these key details. But if coding is still stressing you out, you can always team up with billing pros. Simplify your life with our oncology billing services!
