Oncology Billing Services
A chemotherapy infusion billed without the correct J-code for the drug administered. An immunotherapy session coded without prior authorization documentation. A radiation treatment plan billed at the wrong complexity level. In oncology these errors do not just cost one claim, they repeat across every patient’s entire treatment course.
GenMediTech provides oncology billing services built around the exact coding, drug billing, and compliance requirements that keep cancer care revenue protected across every treatment type.
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- 98% First Pass Clean Claim Rate
- 24–48 Hours Claim Turnaround
- 30% Reduction in A/R
- 100% HIPAA-Compliant
What Are Oncology Billing Services
Oncology billing services manage the full revenue cycle for cancer care practices, from insurance verification and prior authorization through chemotherapy drug billing, radiation treatment coding, and accounts receivable follow-up. Oncology billing is more complex than most specialties because it combines high-cost drug administration, frequent treatment changes, multiple visit types, and payer-specific coverage policies that vary by drug, by diagnosis, and by treatment protocol.
Why Oncology Billing Loses Revenue Most Practices Never Recover
Oncology practices deal with some of the most expensive treatments in medicine. Payers scrutinize every claim. Medical necessity must be documented for every drug administered. Authorization must be secured before treatment begins. One billing error on a high-cost chemotherapy regimen costs significantly more than the same error in any other specialty.
Chemotherapy Drug Billing Done Incorrectly
Every chemotherapy drug has a specific HCPCS J-code that must be billed alongside the administration code. The correct J-code is determined by the drug name, the dose administered, and the route of administration. Billing the wrong J-code, or missing it entirely, results in denial of the drug cost which is often the highest-value component of the claim.
Administration Codes Not Selected Correctly
Chemotherapy administration billing uses a tiered code structure. The first hour of infusion is billed differently from additional hours. Push injections are billed differently from IV infusions. Concurrent infusions have their own rules. Billing the wrong administration code results in systematic underpayment across every infusion visit.
Prior Authorization Not Secured Before Treatment
Most commercial payers require prior authorization for chemotherapy drugs, immunotherapy agents, and targeted therapy before the first dose is administered. Treating without authorization means the drug cost, often thousands of dollars per infusion, gets denied entirely.
Radiation Oncology Treatment Codes Miscoded
Radiation treatment delivery codes are selected based on the treatment technique, number of treatment areas, and complexity of the plan. Simple treatment delivery is coded differently from complex IMRT. A treatment plan billed at the wrong complexity level results in systematic underpayment across every radiation fraction delivered.
Supportive Care Services Not Captured
Oncology practices provide significant supportive care alongside active treatment, hydration infusions, antiemetic injections, growth factor injections, and port management. Each one has its own CPT or HCPCS code. Missing these codes means your practice absorbs the cost of services it never gets paid for.
Drug Waste Not Billed
When a single-dose vial is opened and the full dose is not administered the remaining drug is discarded. Medicare and many commercial payers allow billing for discarded drug amounts using modifier JW. Most practices never bill it, losing recoverable drug costs on every partial vial.
Our Oncology Billing Services
Chemotherapy Drug Billing
We assign correct HCPCS J-codes for every chemotherapy drug administered, matched to the drug name, dose, and administration route documented in the clinical record. Drug waste is captured and billed under modifier JW where payer rules allow.
Your practice stops losing drug revenue to missing or incorrect J-codes across every infusion visit.
Chemotherapy Administration Coding
We apply the correct administration code for every infusion session, initial infusion under CPT 96413, each additional hour under 96415, push injection under 96409, and concurrent infusion under 96417. Every code is selected based on documented administration time and method.
Your infusion revenue reflects exactly what was administered and documented, not a default code that underpays every visit.
Immunotherapy and Targeted Therapy Billing
Immunotherapy agents and targeted therapy drugs each have specific J-codes and prior authorization requirements. We verify authorization before every treatment cycle, assign the correct J-code for each drug, and follow payer-specific coverage policies for newer biologic and immunotherapy agents.
Your highest-cost treatment regimens get billed correctly and paid, instead of denied for missing authorization or incorrect drug codes.
Radiation Oncology Billing
We code radiation treatment planning, simulation, dosimetry, and treatment delivery under the correct CPT codes, from initial treatment planning under 77261 through 77263 to IMRT delivery under 77385 and 77386. Treatment complexity level is selected based on documented treatment technique and number of treatment areas.
Your radiation oncology revenue reflects the actual complexity of every treatment delivered — not the simplified version that underpays your most technically demanding services.
Prior Authorization Management
We secure prior authorization for every chemotherapy drug, immunotherapy agent, and targeted therapy before the first dose is administered. Authorization expiration dates are tracked across every patient's treatment course. Nothing gets administered without coverage confirmation in place.
Your practice stops absorbing drug denials from expired or missing authorizations on treatments that should have been covered.
Supportive Care and Ancillary Service Billing
Hydration infusions, antiemetic administrations, growth factor injections, and port access are each billed under the correct CPT or HCPCS code alongside the primary treatment. Every billable supportive service your practice provides gets captured.
Your practice collects for the full scope of care delivered, not just the headline chemotherapy codes.
Evaluation and Management Coding
Oncology E&M visits are coded under the correct level, 99202 through 99215 for office visits, based on medical decision making complexity. Visits involving highly complex MDM related to active malignancy management are coded at the appropriate level with documentation support.
Denial Management and Appeals
Every denial is reviewed for root cause, wrong J-code, missing authorization, administration code error, medical necessity gap, or drug waste not captured. We correct it and resubmit with supporting clinical documentation. Complex drug coverage denials get formal appeals with clinical evidence and payer policy citations.
Accounts Receivable Follow-Up
Outstanding oncology AR is worked by an aging bucket and payer. High-value drug claims get priority follow-up. Nothing ages past recovery thresholds because individual claims seemed too complex to chase.
Oncology Sub-Specialties We Bill For
Every sub-specialty below has its own coding requirements, drug formularies, and payer authorization rules. We handle all of them.
- Medical Oncology
- Radiation Oncology
- Surgical Oncology
- Gynecological Oncology
- Pediatric Oncology
- Hematology and Oncology
- Immunotherapy and Targeted Therapy
- Bone Marrow Transplant Billing
Oncology CPT and HCPCS Codes We Work With
Chemotherapy Administration
| CPT Code | Description |
|---|---|
|
CPT 96413 |
Chemotherapy infusion, initial, up to 1 hour |
|
CPT 96415 |
Each additional hour of chemotherapy infusion |
|
CPT 96409 |
Chemotherapy push injection, single drug |
|
CPT 96411 |
Each additional push injection |
|
CPT 96417 |
Concurrent chemotherapy infusion, each drug |
|
CPT 96401 |
Chemotherapy injection, non-hormonal, subcutaneous or intramuscular |
Common Chemotherapy J-Codes
| J-Codes | Drug |
|---|---|
|
J9035 |
Bevacizumab (Avastin) per 10mg |
|
J9070 |
Cyclophosphamide per 100mg |
|
J9190 |
Fluorouracil per 500mg |
|
J9355 |
Trastuzumab (Herceptin) per 10mg
|
|
J9999 |
Not otherwise classified antineoplastic drug |
|
J0640 |
Leucovorin calcium per 50mg |
Supportive Care
| CPT Code | Description |
|---|---|
|
CPT 96360 |
Hydration infusion, initial, 31 minutes to 1 hour
|
|
CPT 96361 |
Each additional hour of hydration infusion
|
|
CPT 96372 |
Therapeutic injection, subcutaneous or intramuscular
|
|
CPT 96376 |
Each additional sequential infusion of same drug
|
|
J2405 |
Ondansetron HCl injection per 1mg
|
Radiation Oncology
| CPT Code | Description |
|---|---|
|
CPT 77261 |
Radiation treatment planning, simple
|
|
CPT 77262 |
Radiation treatment planning, intermediate
|
|
CPT 77263 |
Radiation treatment planning, complex
|
|
CPT 77300 |
Basic radiation dosimetry calculation
|
|
CPT 77385 |
IMRT delivery, simple
|
|
CPT 77412 |
Radiation treatment delivery, complex |
Common ICD-10-CM Codes
C50 series covers malignant neoplasm of the breast. C18 series covers malignant neoplasm of the colon. C34 series covers malignant neoplasm of bronchus and lung. C61 covers malignant neoplasm of the prostate. C25 series covers malignant neoplasm of pancreas. C80.1 covers malignant neoplasm without specification of site. Z51.11 covers encounters for antineoplastic chemotherapy. Z51.12 covers encounters for antineoplastic immunotherapy.
Oncology Billing Problems We Fix Every Day
Wrong J-code on a chemotherapy drug?
We match every J-code to the drug name, dose, and administration route in the clinical record. Your drug revenue stops getting denied for J-code errors across every infusion visit.
Prior authorization expired mid-treatment?
We track authorization expiration dates across every patient’s active treatment course. Nothing gets administered without current coverage confirmation.
Radiation treatment codes billed at the wrong complexity?
We select treatment delivery codes based on documented technique and treatment area count. Your radiation revenue reflects actual treatment complexity — not the default code that underpays every fraction.
Supportive care codes never captured?
We identify every billable supportive service — hydration, antiemetics, growth factors, port access — and code each one separately. Your practice gets paid for the full scope of care delivered.
Drug waste never billed?
We identify every partial vial and apply modifier JW where payer rules allow. Recoverable drug costs your practice was absorbing get collected.
Oncology AR aging past 60 days?
We work every aging bucket consistently. High-value drug claims get priority. Nothing ages without active follow-up.
Frequently Asked Questions
Oncology billing combines high-cost drug administration, complex infusion coding, payer-specific prior authorization requirements, and frequent treatment protocol changes, all running simultaneously across every patient's treatment course. Every chemotherapy drug has a specific HCPCS J-code. Every infusion session has a tiered administration code structure. Every new drug or treatment change may require a new authorization. A generalist billing team misses these details constantly.
J-codes are HCPCS Level II codes used to bill for injectable and infusible drugs, including chemotherapy agents, immunotherapy drugs, and supportive care medications. Every drug has its own J-code matched to the specific drug name, dose, and route of administration. Billing the wrong J-code or missing it entirely results in denial of the drug cost, often the highest-value component of an oncology claim.
Modifier JW is applied when a single-dose drug vial is opened, the required dose is administered, and the remaining drug in the vial is discarded. Medicare and many commercial payers allow billing for the discarded drug amount under modifier JW. Most oncology practices never apply it, losing recoverable drug costs on every partial vial used.
Yes. We secure prior authorization before every treatment cycle for chemotherapy drugs, immunotherapy agents, and targeted therapy. Authorization expiration dates are tracked across every patient's active treatment course so nothing gets administered without current coverage in place.
Yes. We handle radiation treatment planning, simulation, dosimetry, and treatment delivery coding, from simple treatment plans through complex IMRT. Treatment complexity level is selected based on documented technique and number of treatment areas.
Yes. We capture depression screening G-codes, immunization documentation, and medication reconciliation, keeping your score above penalty thresholds.
We identify the exact denial reason, wrong J-code, missing authorization, administration code error, or medical necessity gap, fix it at the source, and resubmit with clinical documentation. Drug coverage denials get formal appeals with clinical evidence and payer policy citations.
Yes. Every workflow at GenMediTech follows strict HIPAA protocols, encrypted data handling and controlled access at every step.
Oncology Revenue Lost to Billing Errors Is Revenue Your Practice Already Earned.
Missing J-codes on high-cost drug claims. Drug waste never billed. Prior authorization expired mid-treatment. Radiation treatment complexity undercoded. Every one of these is money your practice earned from real patient care, and never collected.
Our oncology billing specialists are ready to fix that, starting now.
