Eligibility & Verification
Coverage checks before every visit.
Specialty Billing
Oncology Medical Billing
Oncology billing is among the most complex — chemotherapy administration, expensive drugs, and constant prior authorization. We manage J-code drug billing and authorizations so high-cost therapies are fully reimbursed.
The Challenge
Oncology billing, solved
We understand the billing complexities unique to oncology and build them into every claim.
- Chemotherapy administration coding
- Drug (J-code) billing accuracy
- Prior auth for high-cost drugs
What we focus on
- Infusion & administration codes
- Drug wastage (JW) billing
- High-cost drug authorization
Coding Focus
Oncology code sets we work in
The CPT/HCPCS procedure families and ICD-10 diagnosis groups our certified coders handle for this specialty every day.
Common CPT / procedure codes
- 96360–96379IV hydration and therapeutic infusion administration
- 96401–96549Chemotherapy and complex biologic drug administration
- J9000–J9999Injectable antineoplastic and chemotherapy drug supply
- 77261–77799Radiation oncology planning and delivery services
ICD-10 diagnosis focus
- C00–C96 malignant neoplasms by primary site
- Secondary and metastatic site coding to establish medical necessity
- Z51.x encounters for chemotherapy and immunotherapy
- Treatment-related complications such as neutropenia, anemia, and nausea
Code references are shown as general identifiers for illustration. Actual code selection always follows current payer rules and your provider's documentation.
Clean Claims
Modifiers, denials & billing rules we manage
How our team keeps oncology claims compliant — the modifiers that matter, the denials we prevent, and the guidelines we follow.
Key modifiers
- JW
Reports the discarded portion of a single-use drug vial when part of the dose is not administered.
- JZ
Attests that a single-use vial had zero discarded drug, satisfying payer wastage-reporting rules.
- 59
Identifies a separate infusion site or a distinct, non-overlapping administration service in the same encounter.
- 25
Supports a significant, separately identifiable evaluation billed on the same day as drug administration.
Common denials & fixes
Missing or expired prior authorization for high-cost drugs.
Verify authorization and its expiration date before each treatment cycle and re-request early when renewals are pending.
Incorrect infusion hierarchy (initial, sequential, concurrent).
Apply the single primary-administration rule per vascular access and sequence add-on codes to match documented start and stop times.
Drug units billed do not match the J-code unit definition.
Reconcile the administered dose to the code's per-unit measure and report any remainder with JW or attest zero waste with JZ.
Missing or mismatched NDC on drug claim lines.
Capture the NDC, units, and package detail directly from the medication administration record before submission.
Billing guidelines
- Bill only one initial administration code per vascular access unless a separate site is clearly documented.
- Record infusion start and stop times to justify every time-based add-on unit.
- Reconcile ordered, administered, and discarded amounts to support accurate JW and JZ reporting.
- Confirm payer prior-authorization and step-therapy requirements before each cycle to protect drug reimbursement.
End-to-End
What we handle for Oncology
A complete revenue cycle service tailored to your specialty.
Specialty Coding
Certified, specialty-trained coders.
Charge Entry & Claims
Clean, accurate claim submission.
Payment Posting
ERA/EOB posting and reconciliation.
Denial & AR Management
Appeals and aggressive AR recovery.
Reporting & Analytics
Real-time KPIs and insights.
98%
Clean claim rate
30%
Average revenue lift
24/7
Operations coverage
HIPAA
Compliant processes
FAQ
Oncology billing — FAQs
Yes — our certified coders are trained on specialty-specific rules, code sets, and payer policies, and we assign coders with experience in your specialty.
We work in your current practice management system and EHR, so your workflows and reporting stay intact while we handle the billing.
Through accurate specialty coding, front-end eligibility checks, clean claim submission, and relentless denial and AR follow-up — typically lifting first-pass acceptance and net collections.
Always. We use strict access controls, encryption, signed BAAs, and audit trails to protect patient data.
More Specialties
Other specialties we bill for
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