What is the standard insurance baseline for CPT 96402?

The standard insurance baseline reimbursement rate is $32.63. This represents the customary allowable amount established across standard fee schedules.

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CPT 96402Medical Service

Administration of Hormonal Anti-neoplastic Chemotherapy Under Skin or Into Muscle

Q: What do doctors typically charge for Administration of Hormonal Anti-neoplastic Chemotherapy Under Skin or Into Muscle?

The nationwide median physician charge for Administration of Hormonal Anti-neoplastic Chemotherapy Under Skin or Into Muscle (CPT 96402) is $101.00. Doctor billed charges vary based on geographic region, setting, and overhead.

Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle. Clinical pricing breakdown and utilization metrics across 4,765 practicing doctors nationwide.

$101.00

Peer Median Charge

Gross billed rate

$32.63

Standard Baseline

Customary allowable

3.1x

National Markup

Charge vs baseline

4,765

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $101.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $32.63 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 96402 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"