A U.S. based medical billing outsourcing company with extensive experience, Outsource Strategies International (OSI) provides medical billing services for individual physicians, medical practices, clinics, and hospitals.

In today’s podcast, Natalie Tornese, one of our Senior Solutions Managers, discusses about chemotherapy and its CPT codes.

Hello everyone and welcome to our Podcast series. My name is Natalie Tornese and I am a Senior Solutions Manager at Outsource Strategies International. Wanted to take this opportunity to talk a little bit about Chemotherapy.

Chemotherapy is used to destroy rapidly growing cells in the body. The treatment uses powerful chemicals to kill, slow down or prevent the growth of cancer cells. In most cases, chemotherapy is used in combination with other therapies, such as surgery, radiation, or hormone therapy. However, the effectiveness of treatment will depend on the type and stage of cancer and other related factors like the location of the cancer cells, the patients previous cancer treatments and the overall health of the patient. Chemotherapy is considered a systemic treatment, which means it affects the entire body. Though it is an effective way to treat many types of cancer, the treatment has its own risks of side effects. Some side effects are mild and treatable, while others can cause serious complications that can severely impact your quality of life.

The treatment is done to stop or prevent cell division, kill the cancer cells, shrink a tumor before surgery, remove any remaining cancer cells and delay or prevent a reoccurrence, slow the progression on the disease and reduce symptoms in the later stages, even if a cure is unlikely.

In some cases, chemo treatment is also done to treat conditions other than cancer like bone marrow diseases and immune system disorders such as lupus and rheumatoid arthritis. There are certain side effects that occur during chemo therapy treatment which include – nausea, vomiting, pain, mouth sores, loss of appetite, hair loss, fever, fatigue, easy bruising and constipation. But most of these side effects too subside soon after the completion of treatment.

There are different types of chemo that are administered and the stage and the severity of cancer which would tell which type of chemotherapy you would be provided with

This Adjuvant chemotherapy which is usually administered after surgery. This type helps to kill the cancerous cells that may remain undetected and help prevent reoccurrence of the cancer.

Neo-adjuvant chemotherapy is a type of therapy that is administered to shrink too large tumors to make it possible to remove them surgically.

Palliative chemotherapy is done for those cancers that have spread radically and are impossible to remove surgically. Physicians may remove may use palliative chemotherapy to relieve symptoms and make complications less likely, and slow the cancer’s progress or stop it temporarily.

Preparing for chemotherapy depends on the type of drugs received and how they will be administered. Physicians will give specific instructions to the patients to get ready for the procedures in advance. They may recommend several tests and procedures to make sure your body is fit to receive the chemotherapy drugs. Blood tests are normally done to check the kidney, liver and heart functions and providers may also recommend a dental check up to test for the teeth in signs of infection. Treating existing infections may reduce the risk of complications during treatment, since some chemotherapy drugs may reduce your body's ability to fight infections. If there's any problem, physicians may postpone your treatment or select a different chemo drug and dosage that is safer for patients.

Most patients whoever received chemotherapy in a clinical setting, the drugs can be administered in different ways which include - infusions into an artery or vein, injections into the muscle or under the skin, injections into the fluid around your spinal cord or brain, by mouth as tablets, liquid or capsules and topically, onto the skin. Patients who are receiving the chemotherapy intravenously may require a minor surgical procedure to have a thin catheter implanted into a vein to make it easier to administer the drugs. The type of chemo drugs patients receive will depend on several factors like the type and stage of the cancer, previous cancer treatments and overall health of the patient and the extent of recovery after each treatment. The treatment schedules can be either continuous or it may alternate between periods of treatment and periods of rest.

The outlook for a person receiving chemotherapy treatment will largely depend on the type, stage, and location of the cancer and their overall health. In some cases, the patient may receive complete remission. Physicians will regularly monitor the effectiveness of treatment by conducting blood tests and adjust the treatment on that basis.

I will include a transcript along with this podcast that will outline the specific CPT codes associated with this condition and treatment. I hope this helps, but always remember that documentation and a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

( The CPT codes for chemotherapy include –

  • 96360 - Intravenous infusion, hydration; initial, 31 minutes to 1 hour
  • 96361 - Intravenous infusion, hydration; each additional hour
  • 96365 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour
  • 96366 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour
  • 96367 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour
  • 96368 - Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion
  • 96369 - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s)
  • 96370 - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour
  • 96371 - Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s)
  • 96372 - Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
  • 96373 - Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intra arterial
  • 96374 - Therapeutic, prophylactic or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug
  • 96375 - Therapeutic, prophylactic or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug
  • 96376 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility
  • 96377 - Application of on-body injector (includes cannula insertion) for timed subcutaneous injection
  • 96379 - Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion
  • 96401 - Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic
  • 96402 - Chemotherapy administration, subcutaneous or intramuscular; hormonal antineoplastic
  • 96405 - Chemotherapy administration; intralesional, up to and including 7 lesions
  • 96406 - Chemotherapy administration; intralesional, more than 7 lesions
  • 96409 - Chemotherapy administration; intravenous, push technique, single or initial substance/drug
  • 96411 - Chemotherapy administration; intravenous, push technique, each additional substance/drug
  • 96413 - Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
  • 96415 - Chemotherapy administration, intravenous infusion technique; each additional hour
  • 96416 - Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump
  • 96417 - Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour
  • 96420 - Chemotherapy administration, intra-arterial; push technique
  • 96422 - Chemotherapy administration, intra-arterial; infusion technique, up to 1 hour
  • 96423 - Chemotherapy administration, intra-arterial; infusion technique, each additional hour
  • 96425 - Chemotherapy administration, intra-arterial; infusion technique, initiation of prolonged infusion (more than 8 hours), requiring the use of a portable or implantable pump
  • 96440 - Chemotherapy administration into pleural cavity, requiring and including thoracentesis
  • 96446 - Chemotherapy administration into the peritoneal cavity via indwelling port or catheter
  • 96450 - Chemotherapy administration, into CNS (e.g., intrathecal), requiring and including spinal puncture
  • 96521 - Refilling and maintenance of portable pump
  • 96522 - Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (e.g., intravenous, intra-arterial)
  • 96523 - Irrigation of implanted venous access device for drug delivery systems
  • 96542 - Chemotherapy injection, subarachnoid or intra-ventricular via subcutaneous reservoir, single or multiple agents
  • 96549 - Unlisted chemotherapy procedure

HCPCS Code

  • G0498 - Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domiciliary, rest home or assisted living) using a portable pump provided by the office/clinic, includes follow up office/clinic visit at the conclusion of the infusion )