Oncology Billing Services in New York
New York's oncology practices face unique billing challenges shaped by Empire BlueCross BlueShield's commercial rules, NY Medicaid Managed Care requirements, and Novitas Solutions Medicare policies. Our AAPC-certified coders specialize in both NY payer rules and oncology coding complexity.
Why New York Oncology Practices Need Specialized Billing
New York's healthcare market includes 90,000+ physicians, and oncology practices here face a payer market dominated by Empire BlueCross BlueShield on the commercial side and NY Medicaid Managed Care on the public payer side. Medicare claims are processed through Novitas Solutions, which applies its own Local Coverage Determinations that directly affect oncology procedure coverage and medical necessity requirements. Generic billing teams without NY specific knowledge leave revenue on the table.
Oncology billing itself is complex. Oncology billing involves chemotherapy/infusion administration codes (96413-96417), drug product codes (J-codes), radiation therapy coding (77385-77387), and high-complexity E/M for treatment planning. Drug reimbursement (buy and bill) is a significant revenue component. When you combine this coding complexity with New York's specific payer rules, authorization requirements, and 6 NY Medicaid Managed Care managed care plans that each have their own billing rules, you need a team that understands both dimensions. Go Medical Billing provides that expertise at 2.49% of collections, serving oncology practices from New York City to Albany and across New York.
Top CPT Codes for Oncology in New York
Our NY coders handle these oncology codes daily, applying Novitas Solutions Medicare rules and Empire BlueCross BlueShield commercial policies to each claim.
New York Payer Challenges for Oncology
Every NY payer has specific rules for oncology claims. Here's how we navigate them.
Empire BlueCross BlueShield Oncology Claims
Empire BlueCross BlueShield processes the largest share of New York commercial oncology claims. We know their NY specific fee schedules, prior authorization requirements for oncology procedures, and their appeal timelines when claims are denied. Correct HCPCS drug codes with exact dosage units. NDC numbers required by many payers.
NY Medicaid Managed Care Oncology Billing
NY Medicaid Managed Care routes oncology patients through 6 managed care plans: Fidelis Care, Healthfirst, MetroPlus, and 3 more. Each MCO has its own oncology authorization and billing rules that we manage.
Medicare (Novitas Solutions) Oncology Coverage
Novitas Solutions processes Medicare oncology claims in New York with its own Local Coverage Determinations. We navigate Novitas Solutions's policies around infusion administration to prevent medical necessity denials.
Denial Prevention for New York Oncology
Common oncology denials in New York include correct hcpcs drug codes with exact dosage units and sequential, concurrent, and add-on infusion codes based on timing and technique. Our team catches these issues before submission and appeals aggressively with NY payer-specific documentation when denials occur.
Get Expert Oncology Billing in New York
Free billing assessment for your NY oncology practice. See where revenue is leaking.
What We Handle for New York Oncology Practices
New York Oncology Billing Cost Comparison
Hiring an in-house biller with oncology expertise in New York costs $45K-$62K annually in salary alone. Add benefits, software, clearinghouse fees, and office space, and the true cost is even higher. At 2.49% of collections, Go Medical Billing provides an entire team of AAPC-certified oncology coders and NY payer specialists for a fraction of that cost.
$45K-$62K
In-House Biller Salary
+ benefits, software, space
2.49%
Go Medical Billing Rate
Full team, all services included
60-80%
Typical Cost Reduction
With better results
Related Pages
Explore our New York and oncology billing resources.
Frequently Asked Questions
Fix Your New York Oncology Billing
Call 888-701-6090 for a free billing assessment specific to your NY oncology practice. We'll show you where revenue is leaking and how to fix it.