Why Oncology billing is different.
Oncology billing expertise.
- Chemotherapy and immunotherapy administration coding
- Initial, sequential and concurrent infusion hierarchy
- J-code billing with accurate units and JW/JZ modifiers
- Prior authorization tracking for every regimen
- Clinical trial claim coding with required modifiers
- Radiation oncology treatment planning and delivery coding
- Port access and blood draw billing
- Financial assistance and copay program coordination
Common Oncology codes we work with.
| Code | Description |
|---|---|
96413 | Chemotherapy administration, intravenous infusion; up to 1 hour, single or initial drug |
96415 | Chemotherapy administration, intravenous infusion; each additional hour |
96417 | Chemotherapy administration, intravenous infusion; each additional sequential infusion, up to 1 hour |
96401 | Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic |
J9271 | Injection, pembrolizumab, 1 mg |
36591 | Collection of blood specimen from a completely implantable venous access device |
CPT® is a registered trademark of the American Medical Association. Codes shown are examples; correct coding depends on documentation and payer policy.
Our processOncology billing process.
Authorization and Financial Clearance
- Regimen-level prior authorization tracking
- Benefit verification for drugs and administration
- Patient cost estimates for high-dollar therapies
- Enrollment in manufacturer and foundation assistance programs
Oncology Coding
- Infusion hierarchy based on documented start and stop times
- Drug units calculated from dose and vial size
- Wastage reporting with correct modifiers
- Diagnosis coding with staging and treatment status
Claim Submission
- NDC and units validation on every drug line
- Scrubbing for administration and drug edits
- Clinical trial modifiers and identifiers where required
- Electronic submission within 24 hours
Denial Management
- Authorization and medical necessity appeals
- Drug units and wastage corrections
- Compendia-based support for off-label use
- Underpayment recovery against contract rates
Analytics
- Drug margin by payer and regimen
- Infusion chair utilization and revenue
- Authorization turnaround and denial trends
- A/R aging for high-dollar claims
Oncology billing FAQs.
How does infusion hierarchy work?
When multiple drugs are given in one visit, only one service is billed as the initial administration, chosen by payer hierarchy rules such as chemotherapy over therapeutic infusion. Additional drugs are billed as sequential or concurrent services based on documented times.
How do you report drug wastage?
For single-dose vials, Medicare requires the JW modifier for discarded drug amounts and the JZ modifier when nothing was discarded. We report the administered and discarded units on separate lines when applicable.
Can you manage authorizations for chemotherapy regimens?
Yes. We obtain and track authorizations at the regimen level, monitor expiration dates and remaining units, and alert your team before a renewal is due so treatment isn't delayed.
Do you bill clinical trial services?
Yes. We separate routine costs from trial-funded services, apply the required modifiers and condition codes, and include trial identifiers so claims process correctly.