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Oncology Billing Services

Oncology billing is high-dollar and high-complexity. Chemotherapy administration, drug coding (J-codes), radiation therapy, and complex E/M for treatment planning require specialty billing expertise.

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HIPAA Compliant
AAPC Certified
4.9/5 Rating
300+ Practices
96413Chemo Infusion
77385IMRT
J9999Drug Codes
99215Complex E/M

Why Oncology Billing Requires Specialty Expertise

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.

Common Oncology CPT Codes

Our coders handle these oncology codes daily. This is not an exhaustive list.

Code
Description
96413
Chemo Infusion
77385
IMRT
J9999
Drug Codes
99215
Complex E/M

Oncology Billing Challenges We Solve

Common billing problems in oncology and how our team handles them.

Drug Coding (J-Codes)

Correct HCPCS drug codes with exact dosage units. NDC numbers required by many payers.

Infusion Administration

Sequential, concurrent, and add-on infusion codes based on timing and technique.

Buy and Bill

Drug acquisition cost management and adequate reimbursement negotiation.

Radiation Therapy

Treatment planning, simulation, and delivery codes with precise fraction tracking.

Common Oncology Denial Reasons

We prevent these before submission and appeal aggressively when they occur.

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Correct HCPCS drug codes with exact dosage units
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Sequential, concurrent, and add-on infusion codes based on timing and technique
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Drug acquisition cost management and adequate reimbursement negotiation
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Treatment planning, simulation, and delivery codes with precise fraction tracking

Revenue Opportunities Most Oncology Practices Miss

Oncology is one of the highest-revenue specialties per patient, and small coding improvements translate to large dollar amounts. Drug reimbursement (buy-and-bill) is the biggest financial component. Ensuring correct J-code units, NDC documentation, and waste billing (modifier JW for discarded drug) directly impacts drug margin. Infusion administration sequencing is the second major opportunity. When a patient receives pre-medication, chemotherapy, and hydration in the same session, each component has separate administration codes. Missing the hydration code (96360/96361) or pre-medication push (96374) costs $30 to $80 per session across dozens of weekly infusion patients.

Payer-Specific Oncology Billing Tips

Oncology drug prior authorization is extensive. Most commercial payers require auth for every chemotherapy regimen, with NCCN guidelines as the primary coverage criteria. Off-label drug use may be covered if supported by recognized compendia (NCCN, Micromedex, DrugDex). We submit authorization requests with NCCN guideline references. Medicare covers chemotherapy drugs under Part B (buy-and-bill in the office setting) with reimbursement at ASP + 6%. The 340B drug pricing program, if applicable, significantly affects drug margin. Radiation therapy authorization varies by payer — most require treatment plan approval before starting but not per-fraction authorization.

Oncology Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

1
Drug J-codes must include the exact number of billing units based on the drug's HCPCS description — J9271 (pembrolizumab) is per 1 mg, so a 200mg dose = 200 units. NDC number required by many payers.
2
Infusion administration coding follows hierarchical sequencing: initial drug infusion (96413), sequential infusion (96417), concurrent infusion (96415). Document start/stop times for each drug.
3
Treatment planning E/M codes should reflect the full complexity of oncology decision making — most initial oncology consultations support 99205 or 99215.
4
Radiation therapy billing requires separate codes for treatment planning (77263), simulation (77280-77290), and daily treatment delivery (77385-77387). Don't bundle these.

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What We Handle for Oncology Practices

Chemotherapy administration coding
Drug/J-code billing with NDC tracking
Radiation therapy billing (IMRT, SBRT, 3D-CRT)
High-complexity E/M for treatment planning
Infusion timing and sequencing
Drug acquisition cost management

Why Choose Go Medical Billing for Oncology

Oncology is high-dollar billing where coding errors are magnified. Our team handles drug coding, infusion administration sequencing, and radiation therapy with the precision this specialty demands.

We serve oncology practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.

Oncology Billing by State

We handle oncology billing in all 50 states. Select your state for location-specific payer details, Medicaid rules, and Medicare MAC policies.

CaliforniaTexasFloridaNew YorkPennsylvaniaIllinoisOhioGeorgiaNorth CarolinaMichiganNew JerseyVirginiaMassachusettsArizonaTennesseeMarylandIndianaMissouriWisconsinColorado
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Related Resources

Medical Billing & Coding ServicesA/R Recovery ServicesCredentialing & ContractingCase Studies & ResultsPricing

Frequently Asked Questions

We assign correct HCPCS drug codes with exact dosage units and NDC numbers. We also track drug acquisition costs to ensure adequate reimbursement.
Yes. Treatment planning, simulation, daily treatment delivery, and IGRT/IMRT with proper fraction tracking.

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Stop losing revenue to oncology coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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