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Chemotherapy Administration

Reimbursement Policy:
Chemotherapy Administration

Effective Date:
August 1, 2007

Last Revised Date:
July 21, 2014

To provide guidelines for the reimbursement of the administration of chemotherapy.


All products are included, except products where Horizon BCBSNJ is secondary to Medicare (e.g. Medigap).

All Insured and Administrative Services Only (ASO) accounts are included.

Horizon reimburses professionals for both 96413 and 96416 when billed together.

Reimbursement will be considered separately for CPT codes 96413 and 96416.

Limitations and Exclusions:
While reimbursement is considered, payment determination is subject to, but not limited to:

  • Group or Individual benefit
  • Provider Participation Agreement
  • Routine claim editing logic, including but not limited to incidental or mutually exclusive logic, and medical necessity
  • Mandated or legislative required criteria will always supersede.

7/21/2014: Added CPT nomenclature statement.

CPT® is a registered mark of the American Medical Association

Policy 011_v1.0_07012014