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Oncology billing

Oncology Billing & RCM Services

Chemotherapy, immunotherapy and radiation oncology involve the highest-cost drugs and the strictest payer rules in medicine. Specialist billers protect your margins on every treatment.

  • Chemotherapy and immunotherapy administration coding
  • Drug J-codes, NDCs and wastage reporting on every claim
  • Radiation oncology planning, delivery and management billing

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96%
Clean-claim rate target
30%
Fewer drug-related denials
< 35
Days in A/R goal
Overview

Why oncology billing is uniquely high-risk

Oncology practices often purchase drugs that cost thousands of dollars per dose. If a claim is denied because of a missing authorization, an unsupported diagnosis or a unit error, the practice absorbs the loss. Accurate drug billing - HCPCS code, billing units, NDC, and wastage modifiers, is essential.

Administration services follow detailed rules for chemotherapy infusion, push, sequential and concurrent infusions and hydration, based on documented start and stop times. Radiation oncology adds a full course of care, consultation, simulation, treatment planning, dosimetry, delivery and weekly treatment management, each with its own codes.

Payers require prior authorization for most regimens and verify drugs against NCCN-supported indications. An oncology billing partner checks authorizations and coverage before cycle one, tracks regimen changes, connects patients with copay assistance, and appeals denials with clinical evidence.

Why it's hard

Common oncology billing challenges

01

Regimen authorizations

Each chemotherapy or immunotherapy regimen and change in regimen often requires new authorization.

02

Drug units and wastage

Billing units, NDC quantities and JW/JZ modifiers must match administration records exactly.

03

Infusion hierarchy and times

Initial, sequential and concurrent codes depend on drug type and documented times.

04

Radiation course of care

Planning, dosimetry, delivery and weekly management have bundling and frequency rules.

05

Off-label and compendia support

Off-label use must be supported by recognized compendia to be covered.

06

Patient financial burden

High coinsurance requires estimates, copay assistance and payment plans.

What's included

What a oncology billing partner should handle

  • Benefits checks and regimen-level prior authorization
  • Chemotherapy and immunotherapy administration coding
  • Drug J-code, NDC and wastage reporting
  • Radiation oncology coding across the course of care
  • Infusion center and hospital outpatient billing
  • Copay assistance and foundation enrollment
  • Drug inventory and claim reconciliation
  • Denial management with clinical appeals
  • Patient estimates and payment plans
  • Drug margin and payer performance reporting
Coding focus

Key codes in oncology billing

Code(s)What it covers
96413 / 96415Chemotherapy IV infusion, up to 1 hour and each additional hour.
96417Each additional sequential chemotherapy infusion, up to 1 hour.
96401 / 96409Chemotherapy administration, subcutaneous/IM injection and IV push.
96360 / 96375Hydration infusion and sequential IV push of a new drug.
77385 / 77386Intensity-modulated radiation therapy (IMRT) delivery, simple / complex.
77427Radiation treatment management, five treatments.
J9271Injection, pembrolizumab, 1 mg, an example of a drug billed by units.

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Protect drug margins

Verify authorization and coverage before drug is ordered, document administration times and amounts precisely, and reconcile inventory against claims monthly. These steps prevent the largest oncology losses.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven oncology experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their oncology experience.

See all companies
5.0 5 reviews

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...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
No reviews yet

GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
Pricing

How much does oncology billing cost?

Oncology billing fees are often a lower percentage of collections because drug claims are high-dollar, but authorization and appeal workloads are heavy. Compare what each company includes before choosing.

Percentage of collections
3% - 6%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Oncology billing FAQs

With chemotherapy administration codes such as 96413 for the first hour of infusion, add-on codes for additional time and sequential drugs, and separate drug codes for the medications.

Most commercial and Medicare Advantage plans require authorization for regimens and for changes in regimen.

Across the course of care: consultation, simulation, treatment planning, dosimetry, treatment delivery and weekly treatment management each have specific codes.

Incorrect units lead to denials or underpayment and can trigger audits. Units must match the HCPCS descriptor and the amount given.

Yes. Many oncology billing teams enroll eligible patients in manufacturer and foundation copay assistance programs.

Commonly 3% to 6% of collections due to high drug claim values.

Related billing services

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