Oncology Revenue Experts

Specialized Oncology Billing Services

We understand the unique complexities of oncology billing — from chemotherapy administration and radiation oncology coding to immunotherapy, clinical trial billing, and oral drug management — and apply rigorous processes to maximize your reimbursements.

Schedule Free Assessment Our Services
Coding Specialty-matched coders
Denials Root-cause follow-up and appeals
A/R Aged-claim follow-up by payer
Reporting Monthly performance report
Chemo Administration Coding
J-Codes Drug & Biologic Billing
Radiation Oncology Coding Expertise
Compliant Audited Oncology Processes
The Challenge

Why Oncology Billing Is Complex

Oncology practices face some of the most complex billing challenges in healthcare, requiring specialized expertise across chemotherapy, radiation, infusion, and drug management.

01

Chemotherapy Administration Coding

Chemotherapy administration codes (96400-96549) require precise distinction between IV push, infusion, intra-arterial, and intracavitary routes. Each method has specific time documentation requirements, and the addition of antiemetics or supportive care agents during the same session adds significant coding complexity.

02

Drug & Biologic J-Code Management

Oncology drugs and biologics billed through HCPCS J-codes (J9000-J9999) present constant challenges with payer-specific coverage policies, off-label use documentation requirements, and average sales price (ASP) reimbursement methodology. Biosimilar coding, wastage documentation, and prior authorization add further complexity.

03

Radiation Oncology Coding

Radiation oncology codes (77261-77799) span treatment planning, physics/dosimetry, treatment delivery, and management. Proper coding requires understanding of IMRT, SBRT, SRS, brachytherapy, proton beam therapy, and image-guided radiation therapy (IGRT) — each with distinct coding rules and documentation requirements.

04

Immunotherapy & Clinical Trial Billing

Immunotherapy agents including CAR-T cell therapy, checkpoint inhibitors (PD-1/PD-L1), and bispecific T-cell engagers require specialized coding and prior authorization. Clinical trial billing adds another layer of complexity with coordination between research sponsors, Medicare coverage analysis, and proper qualifying trial determination.

Our Process

Our Approach

A structured methodology designed for oncology billing complexity

1

Practice Assessment

We analyze your current billing operations, chemotherapy and radiation modality mix, payer contracts, drug acquisition model, and compliance protocols to identify specific improvement opportunities.

2

Implementation

Tailored implementation with minimal disruption, including staff training on oncology-specific coding, EHR/EHR integration for chemotherapy and radiation documentation, and parallel processing to ensure accuracy from day one.

3

Specialized Coding

Certified oncology coders accurately code all services using latest CPT, HCPCS, and ICD-10 guidelines with expertise in chemotherapy administration, J-code drug billing, radiation oncology, and E/M with medical necessity for cancer care.

4

Claim Management

Claims submitted within 24 hours with continuous monitoring, proactive follow-up, and aggressive denial prevention strategies specific to oncology — including off-label use appeals and drug wastage documentation verification.

5

Analytics & Optimization

Detailed financial reports and actionable insights for ongoing optimization, including drug cost vs. reimbursement analysis, modality-level profitability, and denial pattern tracking by payer and drug.

What We Do

Our Services

Comprehensive revenue cycle management for oncology practices

⚙

Chemotherapy Administration Coding

Expert coding for IV push, infusion, intra-arterial, and intracavitary chemotherapy (96400-96549) including correct route identification, time-based infusion coding, and proper sequencing with supportive care services. Expertise in push vs. infusion distinction and hydration bundling rules.

ℹ

Drug & Biologic J-Code Billing

Comprehensive HCPCS J-code management for all oncology drugs and biologics (J9000-J9999) including proper units calculation, wastage documentation, biosimilar coding with appropriate modifiers, and payer-specific off-label use coverage policy expertise.

☢

Radiation Oncology Coding

Specialized coding for treatment planning, physics/dosimetry, treatment delivery, and management (77261-77799) including IMRT, SBRT, SRS, brachytherapy, proton therapy, and IGRT. Proper coding of simulation, immobilization devices, and weekly management services.

♢

Immunotherapy & CAR-T Billing

Specialized billing for immunotherapy agents including checkpoint inhibitors, CAR-T cell therapy, and bispecific antibodies. Expertise in prior authorization, medical necessity documentation, and coordination between drug administration and monitoring services.

☰

Clinical Trial Billing

Comprehensive clinical trial billing management including Medicare coverage analysis, qualifying trial determination, routine cost distinction from research procedures, and proper coordination with trial sponsors and institutional review boards.

↩

Denial Management & Appeals

Proactive denial prevention and recovery with specialized expertise in oncology-specific denials including off-label use medical necessity, drug wastage disputes, incorrect J-code assignments, and radiation oncology coding controversies.

Protection

Security & Compliance

We prioritize data protection and regulatory compliance

🔒

HIPAA Compliant

Billing processes designed around HIPAA-compliant data handling.

◆

Data Protection

Encryption, secure transmission protocols, and access controls protect patient data.

📋

Compliance Programs

Coding and billing work is reviewed against current payer and CMS rules.

FAQ

Frequently Asked Questions

Common questions about our oncology billing services

We meticulously distinguish between IV push (96409-96425), infusion (96401-96417), intra-arterial (96420-96425), and intracavitary (96445-96450) routes based on documentation. Our coders track infusion start/stop times precisely and apply correct coding for sequential administrations. We also navigate payer-specific rules about chemotherapy versus non-chemotherapy infusion distinction and proper use of hydration add-on codes.

Our J-code billing specialists maintain a comprehensive drug database updated with the latest HCPCS codes, NDC requirements, and ASP reimbursement rates. We ensure proper units calculation based on administration documentation, handle wastage documentation with modifier JW/JZ requirements, and manage biosimilar coding with appropriate modifiers. We also track payer-specific off-label use policies and prior authorization requirements for each drug.

Our radiation oncology specialists understand the full spectrum of radiation therapy coding from simple to complex. We properly code treatment planning, simulation, physics/dosimetry, and treatment delivery for IMRT, SBRT, SRS, brachytherapy, and proton therapy. We ensure correct coding of image guidance, immobilization, and weekly management services while navigating payer-specific coverage policies for advanced radiation techniques.

Immunotherapy billing requires specialized knowledge of unique coding for checkpoint inhibitors, CAR-T cell therapy, and bispecific antibodies. We manage the complex prior authorization process, ensure proper medical necessity documentation, coordinate between drug administration codes and monitoring services, and handle the unique billing requirements for CAR-T including the six-digit CPT codes and specific diagnosis documentation required for coverage.

Yes. Our team has expertise in clinical trial billing including Medicare Coverage Analysis, qualifying clinical trial determination, and proper distinction between routine care costs and research procedures. We coordinate with trial sponsors, manage coverage analysis documentation, ensure correct coding for clinical trial services, and maintain compliance with NCD 310.1 requirements for clinical trial billing.

Ready to Optimize Your Oncology Revenue Cycle?

Schedule a complimentary assessment with our oncology billing team. We'll analyze your current billing workflow and provide personalized recommendations.

  • Personalized workflow analysis
  • Custom recommendations
  • Competitive pricing quote
  • No-obligation assessment

Request Free Assessment

Receive a complimentary analysis of your billing workflow

Please don't include patient names or health information.

We respect your privacy. Your information will only be used to contact you about our services.

✓

Thank You!

We've received your request and will contact you.