Cost analysis for CPT 96401 — Administration of non-hormonal anti-neoplastic chemotherapy under skin or into muscle
Average Medicare Payment
$55.92
2023 data
Total Payments (2023)
$39.4M
Services (2023)
694.0K
Price Change (2014–2023)
-1.0%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $56.51 | $28.5M | 498.2K | — |
| 2015 | $57.55 | $32.6M | 559.9K | +1.8% |
| 2016 | $57.20 | $34.2M | 592.3K | -0.6% |
| 2017 | $56.91 | $31.8M | 551.9K | -0.5% |
| 2018 | $61.07 | $33.7M | 544.2K | +7.3% |
| 2019 | $61.21 | $36.3M | 585.7K | +0.2% |
| 2020 | $61.19 | $36.5M | 590.2K | -0.0% |
| 2021 | $63.37 | $37.8M | 587.0K | +3.6% |
| 2022 | $58.99 | $34.3M | 572.3K | -6.9% |
| 2023 | $55.92 | $39.4M | 694.0K | -5.2% |
The most expensive state pays 1.5x more than the cheapest for this procedure. DC averages $66.53 vs HI at $44.97.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| DC | $66.53 | $129.1K | 1.9K | 9 |
| CA | $65.80 | $3.0M | 44.9K | 208 |
| NY | $65.38 | $1.5M | 23.4K | 161 |
| NJ | $63.45 | $2.7M | 43.3K | 215 |
| MD | $63.25 | $2.3M | 36.7K | 185 |
| AK | $62.85 | $56.0K | 891 | 9 |
| CT | $62.53 | $77.9K | 1.2K | 14 |
| MA | $61.47 | $304.3K | 5.0K | 20 |
| CO | $59.20 | $655.6K | 11.1K | 87 |
| VA | $58.82 | $2.1M | 34.9K | 179 |
| RI | $58.72 | $42.1K | 717 | 2 |
| WA | $58.24 | $203.4K | 3.5K | 37 |
| SD | $57.99 | $13.5K | 233 | 1 |
| VT | $57.82 | $26.8K | 463 | 3 |
| IL | $57.65 | $1.1M | 19.4K | 165 |
| PA | $57.44 | $2.4M | 41.3K | 186 |
| MN | $57.17 | $303.0K | 5.3K | 81 |
| ND | $57.16 | $7.0K | 122 | 1 |
| NV | $56.84 | $234.8K | 4.1K | 33 |
| DE | $56.12 | $532.5K | 9.5K | 29 |
| OR | $55.95 | $197.2K | 3.5K | 40 |
| FL | $55.78 | $7.5M | 133.6K | 585 |
| GU | $55.61 | $12.0K | 216 | 1 |
| PR | $55.53 | $9.1K | 164 | 2 |
| TX | $54.15 | $4.7M | 87.2K | 478 |
| MI | $54.03 | $443.4K | 8.2K | 77 |
| NH | $54.02 | $20.4K | 377 | 4 |
| WI | $53.97 | $105.8K | 2.0K | 15 |
| ME | $53.69 | $43.0K | 800 | 7 |
| AZ | $53.65 | $1.2M | 22.3K | 104 |
| NC | $53.21 | $753.7K | 14.2K | 79 |
| GA | $52.82 | $561.4K | 10.6K | 78 |
| KS | $52.50 | $253.2K | 4.8K | 28 |
| NM | $52.37 | $135.4K | 2.6K | 20 |
| UT | $52.30 | $204.8K | 3.9K | 15 |
| SC | $52.01 | $618.3K | 11.9K | 66 |
| OH | $51.99 | $449.6K | 8.6K | 64 |
| MO | $51.92 | $227.9K | 4.4K | 55 |
| IA | $51.87 | $324.0K | 6.2K | 44 |
| ID | $51.69 | $30.7K | 594 | 5 |
| LA | $50.54 | $582.4K | 11.5K | 45 |
| NE | $50.15 | $351.1K | 7.0K | 32 |
| OK | $50.09 | $122.3K | 2.4K | 19 |
| AL | $50.05 | $381.6K | 7.6K | 60 |
| IN | $50.04 | $493.4K | 9.9K | 62 |
| TN | $49.78 | $722.7K | 14.5K | 105 |
| AR | $49.45 | $515.0K | 10.4K | 60 |
| KY | $48.36 | $257.0K | 5.3K | 18 |
| WV | $47.69 | $50.3K | 1.1K | 10 |
| MS | $46.71 | $449.4K | 9.6K | 63 |
| HI | $44.97 | $10.0K | 222 | 1 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Vinicius Costa Diniz Domingues | Rheumatology | FL | $287.9K | 5.2K | $55.82 |
| Nehal Gandhi | Rheumatology | PA | $192.1K | 3.1K | $62.20 |
| Elizabeth Clayton | Rheumatology | MD | $184.1K | 3.1K | $60.28 |
| Marc Hirsh | Rheumatology | FL | $171.5K | 2.9K | $59.30 |
| Steven Golombek | Rheumatology | NJ | $157.0K | 2.4K | $65.95 |
| Vipul Joshi | Rheumatology | FL | $150.1K | 2.7K | $55.06 |
| Phong Nguyen | Rheumatology | VA | $138.0K | 2.2K | $62.38 |
| Victoria Katz | Rheumatology | NY | $138.0K | 2.0K | $68.44 |
| Arash Horizon | Rheumatology | CA | $116.7K | 1.7K | $68.45 |
| Claude Abujrab-Saba | Internal Medicine | VA | $114.4K | 1.8K | $63.71 |
| Richard Haddad | Rheumatology | NJ | $101.1K | 1.6K | $64.21 |
| William Sunshine | Rheumatology | FL | $98.6K | 1.7K | $57.47 |
| Vedashree Panthulu | Rheumatology | FL | $94.9K | 1.7K | $54.34 |
| Mohamed Aboyoussef | Rheumatology | FL | $94.2K | 1.7K | $55.21 |
| Sean Wollaston | Rheumatology | CA | $92.9K | 1.5K | $63.83 |
| Suneet Grewal | Rheumatology | CA | $90.4K | 1.2K | $77.40 |
| Seth Coren | Orthopedic Surgery | FL | $88.7K | 1.5K | $59.40 |
| Ahmed Abdel-Megid | Rheumatology | NJ | $87.3K | 1.3K | $65.47 |
| Anthony Botti | Hematology-Oncology | NJ | $87.0K | 1.3K | $67.36 |
| Jyothi Mallepalli | Rheumatology | LA | $83.7K | 1.6K | $51.30 |
Based on the data, CPT 96401 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.
Costs have decreased 1% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.
This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.