Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...
Hematology Billing Services
Infusions, transfusions, bone marrow procedures and high-cost drugs make hematology one of the most financially sensitive specialties. Specialist billers protect every dose and every hour.
- Infusion hierarchy and time-based administration coding
- High-cost drug J-codes, NDCs and wastage (JW/JZ) reporting
- Prior authorization for biologics, iron and specialty drugs
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Why hematology billing is high stakes
Hematology practices administer expensive drugs - IV iron, immunoglobulins, growth factors and biologics, and every unbilled unit or denied claim is a direct loss on drug that has already been purchased. Drug billing requires the correct HCPCS J-code, billing units, NDC and, for single-dose vials, reporting of discarded amounts with JW or JZ modifiers.
Infusion administration follows a hierarchy: chemotherapy and complex drugs first, then therapeutic infusions, then hydration, with initial, sequential and concurrent codes based on start and stop times. Missing times or wrong hierarchy choices are common causes of underpayment.
Hematologists also perform bone marrow aspirations and biopsies, manage transfusions and order complex lab panels. A hematology billing team verifies coverage and authorizations before treatment, reconciles drug inventory against claims and works denials quickly so cash flow keeps pace with drug purchasing.
Common hematology billing challenges
Drug units and NDC reporting
J-code billing units, NDC quantities and wastage must be reported precisely for each dose.
Infusion hierarchy
Initial, sequential and concurrent infusion codes depend on drug type and documented times.
Prior authorization delays
Biologics and specialty drugs require authorizations that delay treatment if not handled early.
Buy-and-bill financial risk
A denied drug claim can cost the practice thousands of dollars per patient.
Medical-necessity diagnoses
Drugs must be linked to covered diagnoses under payer and Medicare policies.
Bone marrow procedure coding
Aspiration and biopsy at the same site and session have specific code combinations.
What a hematology billing partner should handle
- Benefits and specialty drug coverage verification
- Prior authorization and renewal tracking
- Infusion administration hierarchy coding
- J-code, NDC and JW/JZ wastage reporting
- Drug inventory and claim reconciliation
- Bone marrow and transfusion procedure coding
- Patient assistance and copay program support
- Denial management and appeals
- Underpayment tracking against drug costs
- Monthly revenue and drug-margin reports
Key codes in hematology billing
| Code(s) | What it covers |
|---|---|
| 96365 / 96366 | IV infusion for therapy or diagnosis, initial hour and each additional hour. |
| 96413 / 96415 | Chemotherapy or complex drug infusion, initial hour and each additional hour. |
| 96360 / 96361 | IV hydration, initial hour and each additional hour. |
| 38220 / 38221 / 38222 | Bone marrow aspiration, biopsy, and biopsy with aspiration. |
| 36430 | Transfusion of blood or blood components. |
| J-codes | HCPCS drug codes for IV iron, immunoglobulins and other injectables, billed in defined units. |
| JW / JZ | Modifiers reporting discarded drug amounts or confirming no wastage from single-dose containers. |
Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.
Drug wastage reporting
Medicare requires the JW modifier for discarded amounts from single-dose containers and the JZ modifier when there is no wastage. Missing these modifiers can lead to denials and audit findings.
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How much does hematology billing cost?
Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.
Most common. You pay only on money collected.
Predictable for high-volume, low-complexity claims.
Dedicated billers working inside your systems.
Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.
Hematology billing FAQs
By the infusion hierarchy: complex drug or chemotherapy infusions are primary, followed by therapeutic infusions and hydration, using documented start and stop times.
JW reports drug amounts discarded from single-dose vials; JZ confirms that no drug was wasted. Medicare requires one of them on applicable drug claims.
Yes. Specialist billers submit initial authorizations, track expiration dates and file renewals before treatment is interrupted.
Verify coverage and authorization before ordering drug, link drugs to covered diagnoses, and report units and NDCs exactly as administered.
Yes, including aspiration, biopsy and the combined code when both are done at the same site.
Typically 4% to 7% of collections, depending on drug volume and authorization workload.
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