Oncology Practices
Clean Claim Rate
Revenue Recovered
Drug Claims
Oncology billing operates at a level of complexity that most billing companies cannot handle. Chemotherapy drug codes change quarterly. Administration billing requires precise infusion time tracking. And the interplay between medical oncology E/M visits, drug costs, and treatment planning creates a billing environment where expertise is not optional.
We bring oncology-specific knowledge to every claim. Our coders stay current on HCPCS drug code updates, understand the hierarchy of infusion and injection administration codes, and ensure that your practice captures the full value of every treatment session.
Every Oncology billing team deals with payer delays, coding nuance, and collection leakage. We tighten those weak points before they turn into write-offs.
HCPCS J-codes for oncology drugs update quarterly. New biosimilars, dose-based code changes, and NDC-to-HCPCS crosswalk updates mean that billing staff must stay current or risk submitting claims with incorrect drug codes.
Chemotherapy infusion billing follows a strict hierarchy: initial infusion (96413), sequential infusion (96415), concurrent infusion (96417), and push codes (96409, 96411). Violating the hierarchy triggers automatic denials.
Oncology practices purchase high-cost drugs and bill payers for reimbursement. The gap between acquisition cost and reimbursement (ASP+6% for Medicare) must be managed carefully to avoid financial losses on expensive drug regimens.
Multi-cycle chemotherapy regimens require ongoing prior authorization. Each cycle, drug change, or dose adjustment may trigger a new authorization requirement. Missing a single authorization can result in zero reimbursement for a $10,000+ treatment session.
Support spans the full revenue cycle, from front-end verification to denial recovery and reporting.
Chemotherapy and immunotherapy drug billing (J-codes, Q-codes)
Infusion administration hierarchy coding (96413-96417, 96409-96411)
Drug acquisition cost tracking and ASP reimbursement analysis
Prior authorization for treatment regimens and cycle renewals
Radiation therapy billing coordination
Clinical trial billing compliance and coverage analysis
We support independent practices, multisite groups, and growing provider organizations with flexible workflows.
Independent physician groups
Multi-location practices
Private equity backed platforms
Hospital-owned outpatient groups
Oncology billing operates at a level of complexity that most billing companies cannot handle. Chemotherapy drug codes change quarterly. Administration billing requires precise infusion time tracking. And the interplay between medical oncology E/M visits, drug costs, and treatment planning creates a billing environment where expertise is not optional.
We bring oncology-specific knowledge to every claim. Our coders stay current on HCPCS drug code updates, understand the hierarchy of infusion and injection administration codes, and ensure that your practice captures the full value of every treatment session.
Answers to the questions practice owners and managers ask most often before switching billing partners.
We monitor CMS HCPCS quarterly updates and drug manufacturer notifications. When a J-code changes, we update our coding system immediately and retroactively review any claims submitted with the old code during the transition period. This prevents the revenue disruption that delayed code adoption causes.
The hierarchy determines billing order when multiple drugs are infused in one session. The primary chemotherapy infusion is billed first (96413), followed by sequential infusions (96415), with concurrent infusions last (96417). Push medications use separate codes (96409, 96411). Violating this order causes denials across the entire treatment session.
We track acquisition cost per drug, compare against payer reimbursement rates (Medicare ASP+6%, commercial contracted rates), and flag drugs where reimbursement falls below cost. This analysis helps practices make informed decisions about drug purchasing and participation in 340B or GPO programs.
Yes. Radiation oncology billing involves treatment planning codes (77261-77263), simulation (77280-77295), and daily treatment delivery codes (77385-77387 for IMRT). We coordinate radiation and medical oncology billing to ensure no claim conflicts or duplicate charges.
Oncology prior authorizations often require clinical documentation including pathology reports, staging information, genomic test results, and treatment protocol justification. We compile these documents proactively and submit authorization requests before the first treatment cycle to prevent delays.
Clinical trial billing requires separating routine care costs (billable to insurance) from investigational costs (covered by the trial sponsor). We apply the Q1 modifier for qualifying clinical trials and maintain clear documentation of which services fall under each category.
The difference is operational discipline. We focus on clean submissions, fast follow-up, and transparency.
Get a revenue review and a clear action plan tailored to your practice, payers, and claim mix.