Look to These Documents for Correct Chemo Pump Coding
Question: Can you point to any documentation that shows 96416 is not the correct code for reporting chemotherapy pumps for Medicare patients? AAPC Forum Participant Answer: Even though the document was officially retired effective Dec. 11, 2025, the Centers for Medicare & Medicaid Services (CMS) article A55134, “Billing and Coding: Prolonged Drug and Biological Infusions Started Incident To a Physician’s Service Using an External Pump,” contains definitive information regarding correct coding for the kind of chemotherapy infusion pump referred to by 96416 (Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump). In fact, the document notes another 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), “is to be used when billing prolonged drug and biological infusions for chemotherapy administration started incident to a physician’s service using an external pump.” The code descriptor language specifically states that the chemotherapy administration should be conducted “using a portable pump provided by the office/clinic.” The guidance contained in article A55134 is echoed in the American Hospital Association’s (AHA’s) AHA Coding Clinic® for HCPCS article “Appropriate reporting of HCPCS code G0498” (Volume 17, Number 2, 2017), which states “G0498 describes a service where the facility incurred a facility expense specific to the provision of the non-implantable, external infusion pump.” In addition to the pump, G0498 also “includes the chemotherapy administration,” which means the “code should not be reported with CPT® code 96416,” according to Coding Clinic® for HCPCS. This guidance also appears in article A55134. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
