How To Use CPT Code 96401

CPT 96401 refers to the administration of non-hormonal, antineoplastic chemotherapy drugs via subcutaneous or intramuscular routes. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 96401.

1. What is CPT 96401?

CPT 96401 is a medical billing code used to describe the administration of non-hormonal, antineoplastic chemotherapy drugs through subcutaneous or intramuscular routes. This code is utilized by healthcare providers to bill for the service of administering these specific types of chemotherapy drugs to patients.

2. 96401 CPT code description

The official description of CPT code 96401 is: “Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic.”

3. Procedure

The procedure for CPT 96401 involves the following steps:

1. The healthcare provider discusses the risks and benefits of the chemotherapy treatment with the patient.
2. The patient provides informed consent for the treatment.
3. The provider prepares the non-hormonal, antineoplastic chemotherapy drugs for administration.
4. The provider administers the drugs to the patient via subcutaneous or intramuscular injection.
5. The provider monitors the patient for any adverse reactions or side effects during and after the administration of the drugs.

4. Qualifying circumstances

Patients eligible to receive CPT code 96401 services are those who:

• Have a cancer diagnosis that requires treatment with non-hormonal, antineoplastic chemotherapy drugs.
• Are not contraindicated for the specific chemotherapy drugs being administered.
• Have provided informed consent for the treatment.
• Are under the care of a healthcare provider who is qualified to administer chemotherapy drugs.

5. When to use CPT code 96401

It is appropriate to bill the 96401 CPT code when a healthcare provider administers non-hormonal, antineoplastic chemotherapy drugs to a patient via subcutaneous or intramuscular routes. This code should be used only for the administration of these specific types of chemotherapy drugs and not for other types of chemotherapy or drug administration.

6. Documentation requirements

To support a claim for CPT 96401, the following information should be documented:

• Patient’s cancer diagnosis and treatment plan.
• Risks and benefits of the chemotherapy treatment discussed with the patient.
• Patient’s informed consent for the treatment.
• Specific non-hormonal, antineoplastic chemotherapy drugs administered.
• Route of administration (subcutaneous or intramuscular).
• Dosage and frequency of the chemotherapy drugs.
• Monitoring and management of any adverse reactions or side effects during and after the administration of the drugs.

7. Billing guidelines

When billing for CPT code 96401, keep in mind the following guidelines:

• Report the HCPCS code for the drug separately if the provider purchased the drug to administer to the patient.
• Do not use CPT 96401 for the administration of hormonal chemotherapy drugs or other types of drug administration.
• Ensure that all required documentation is complete and accurate to support the claim.

8. Historical information

CPT 96401 was added to the Current Procedural Terminology system on January 1, 2006. There have been no updates to the code since its addition.

9. Similar codes to CPT 96401

Five similar codes to CPT 96401 and how they differ are:

• CPT 96402: Involves the administration of hormonal anti-neoplastic chemotherapy drugs, rather than non-hormonal drugs.
• CPT 96409: Refers to the intravenous administration of chemotherapy drugs, rather than subcutaneous or intramuscular routes.
• CPT 96413: Covers the administration of chemotherapy drugs via infusion, rather than injection.
• CPT 96415: Pertains to the continued administration of chemotherapy drugs via infusion, following the initial infusion service.
• CPT 96450: Involves the administration of chemotherapy drugs directly into the central nervous system, rather than subcutaneous or intramuscular routes.

10. Examples

Here are 10 detailed examples of CPT code 96401 procedures:

1. A patient with breast cancer receives a subcutaneous injection of a non-hormonal, antineoplastic chemotherapy drug as part of their treatment plan.
2. A patient with lung cancer is administered an intramuscular injection of a non-hormonal, antineoplastic chemotherapy drug to help shrink their tumor.
3. A patient with colorectal cancer receives a subcutaneous injection of a non-hormonal, antineoplastic chemotherapy drug as a part of their chemotherapy regimen.
4. A patient with ovarian cancer is administered an intramuscular injection of a non-hormonal, antineoplastic chemotherapy drug to help control the growth of their cancer.
5. A patient with pancreatic cancer receives a subcutaneous injection of a non-hormonal, antineoplastic chemotherapy drug as a part of their treatment plan.
6. A patient with melanoma is administered an intramuscular injection of a non-hormonal, antineoplastic chemotherapy drug to help reduce the size of their tumor.
7. A patient with stomach cancer receives a subcutaneous injection of a non-hormonal, antineoplastic chemotherapy drug as a part of their chemotherapy regimen.
8. A patient with kidney cancer is administered an intramuscular injection of a non-hormonal, antineoplastic chemotherapy drug to help control the growth of their cancer.
9. A patient with bladder cancer receives a subcutaneous injection of a non-hormonal, antineoplastic chemotherapy drug as a part of their treatment plan.
10. A patient with esophageal cancer is administered an intramuscular injection of a non-hormonal, antineoplastic chemotherapy drug to help shrink their tumor.