Oncology billing
Oncology billing services
We handle billing for oncology and hematology practices, from chemotherapy and infusion administration to high-cost drug claims and office visits. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Infusion hierarchy applied so the right service is billed as initial
- Drug units, NDCs and JW/JZ wastage reported on every claim
- Prior authorization checked for each regimen before treatment
Why oncology billing is different
In oncology, one denied drug claim can be thousands of dollars
Oncology practices buy expensive drugs up front and bill for them later. A small error in units, authorization or administration coding can wipe out the margin on a whole treatment day.
Administration hierarchy
When a patient gets chemotherapy, other infusions and hydration on the same day, CPT rules decide which service is the initial one. Chemotherapy ranks above therapeutic infusions, which rank above hydration. Only one initial service is billed per encounter in most cases.
Time and sequence
Infusion codes depend on start and stop times. An additional hour, a sequential drug and a concurrent infusion each have their own add-on code. Missing times are one of the most common reasons infusion lines are denied.
Drug units and NDCs
Each drug is billed in HCPCS units that often differ from the dose in milligrams. Many payers, including Medicaid plans, also require the NDC, its unit and quantity. Biosimilars have their own codes.
Wastage modifiers
For single-dose vials, the unused amount is reported on a separate line with modifier JW, or modifier JZ is added when nothing was discarded. Medicare requires this, and many other payers follow.
Prior authorization and pathways
Most commercial payers require authorization for chemotherapy and supportive drugs, often by regimen. A change in drug, dose or cycles may need a new authorization.
E/M on treatment days
An office visit on the same day as chemotherapy can be billed only when it is significant and separate from the pre-treatment assessment, with modifier 25 and supporting documentation.
Common codes
Oncology codes we review before every claim
| Code(s) | What it is | What we watch for |
|---|---|---|
| 96413 / 96415 / 96417 | Chemotherapy IV infusion: first hour, each additional hour, sequential drug | Hierarchy, start and stop times, one initial service |
| 96401 / 96402 / 96409 | Chemotherapy by injection or IV push, including hormonal anti-cancer drugs | Drug is classed as chemotherapy under CPT or payer policy |
| 96365 / 96366 / 96367 | Therapeutic IV infusion: first hour, additional hour, sequential | Reported as initial only when no chemo is given that day |
| 96360 / 96361 | IV hydration | Minimum time and medical necessity; not bundled into chemo time |
| J9000–J9999 / Q5101 and up | Chemotherapy drugs and biosimilars | Units per HCPCS descriptor, NDC, JW/JZ modifier |
| 96523 | Flushing an implanted port or catheter | Billed only when no other service is performed that day |
| 99213–99215 + modifier 25 | Established patient visit on a treatment day | Separate problem documented beyond routine pre-treatment check |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
The oncology denials we stop before they happen
Most oncology denials come from drugs and administration, not the visit. We check both on every claim.
- Drug units that do not match the HCPCS billing unit or the dose given
- Missing or invalid NDC, NDC unit or quantity
- Missing JW or JZ modifier on single-dose vial drugs
- Authorization expired, or approved for a different drug, dose or number of cycles
- Two initial administration codes billed on one encounter, or hierarchy applied in the wrong order
- Infusion time missing, so additional-hour codes are denied
- Diagnosis coding that does not support the drug under the payer’s coverage policy
What we handle
Everything between the treatment and the payment
Our core focus is behavioral health. We bill oncology practices with the same team, the same process and the same promises.
- Insurance eligibility, benefits and prior authorization checks before treatment
- Charge entry and coding review of administration, drug and E/M codes
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation, including drug underpayments
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Commercial, Medicare and Medicaid credentialing for every provider
- Patient statements and balance tracking (patient calls go to your office or an optional RevenueCTRL virtual assistant)
- Monthly reporting on collections, denials and A/R
Pricing
Clear pricing for oncology practices
Billing starts at 2.5% of collections, or a flat monthly fee. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free when you sign up for billing. No setup fee and no long-term contract.
Common questions
How do you choose the initial infusion code?
We follow the CPT hierarchy: chemotherapy first, then therapeutic infusions, then hydration, and infusions before pushes and injections. The initial code goes to the highest-ranking service, and the rest are billed as sequential, concurrent or additional-hour add-ons based on documented times.
Do you report drug wastage?
Yes. For single-dose vials we bill the administered amount on one line and the discarded amount on a separate line with modifier JW. When nothing is discarded we add modifier JZ. We need the dose and wasted amount documented in the chart.
Do you check prior authorization for chemo regimens?
Yes. We confirm that an authorization is on file and that it covers the drug, dose and number of cycles before the claim goes out. When a regimen changes, we flag it so your team can update the authorization.
Can you bill an office visit on the same day as chemotherapy?
Yes, when the visit addresses a significant, separate problem beyond the routine check before treatment. We bill it with modifier 25 and make sure the note supports it. A routine pre-treatment assessment is included in the administration codes.
Do you talk to patients about their balances?
No. Our billing team does not call patients. We send statements and track balances, and patient calls go to your office or to an optional RevenueCTRL virtual assistant.
Which EHRs do you work in?
We work in athenahealth, AdvancedMD, eClinicalWorks, Tebra (Kareo), DrChrono and others. We use the system you already have.
Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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