Specialized billing for cancer care — chemotherapy J-code drug billing, infusion administration coding, prior authorization, and high-dollar denial management by oncology billing experts. Serving practices nationwide across the United States.
Get Free Practice Audit Contact UsComprehensive billing coverage for your oncology practice
Exact-unit J-code billing for chemotherapy, targeted therapy, and biologics — the highest-dollar line items in the practice.
Correct infusion/injection hierarchy — initial, sequential, and concurrent codes with hydration and push, driven by time.
Documented single-use vial waste captured with JW, and JZ where there is none — real money at oncology drug prices.
Regimen-level authorization matched to the exact drug, dose, and cycle billed — the #1 high-dollar denial risk.
Hematology visits, injections, and blood-product administration coded to the documented service and indication.
We appeal medical-necessity, authorization, and unit denials — where a single oncology denial is a five-figure problem.
Oncology is the highest-stakes billing in outpatient medicine. A single infusion visit can carry drug charges in the tens of thousands of dollars, so the errors that are minor annoyances in other specialties become catastrophic here: one wrong unit, one missing modifier, one authorization that doesn't match the regimen, and a five-figure claim denies. The upside is equally large — a well-run oncology revenue cycle protects the enormous drug spend the practice fronts on behalf of patients. This is a specialty where billing precision isn't administrative housekeeping; it's financial survival.
In oncology, the drug dwarfs everything else on the claim. Chemotherapy, targeted therapies, and biologics are billed with HCPCS J-codes by exact units, and because the per-unit cost is so high, a units miscalculation or a J-code that doesn't match the administered agent is an immediate, large denial. Add the waste rules — the JW modifier reports discarded single-use vial drug, JZ confirms none was wasted — and the documentation-to-billing link becomes a compliance requirement, not an option. We bill the drug with the same care the pharmacy dispenses it, because at these prices a rounding habit is real lost revenue. Unit and frequency denials (CO-151) get worked immediately, not queued.
Administering the drug is billed separately from the drug itself, and the infusion/injection hierarchy is unforgiving of sloppy documentation. Each encounter has one initial service (for example, 96413 for the first hour of IV chemotherapy infusion), with add-on codes for additional hours (96415), sequential infusions (96417), concurrent infusions, hydration, and therapeutic pushes — all driven by documented start/stop times and the correct hierarchy of what counts as "initial." Miscode the sequence and the administration underpays even when the drug is right. We build the administration claim from the flowsheet times, so the visit is captured completely.
Nearly every oncology drug requires prior authorization, and here the authorization has to match the exact drug, dose, and regimen cycle — not just "chemotherapy." Because the dollars are so large, an auth-to-claim mismatch is the most damaging denial an oncology practice can take: the treatment is delivered, the drug is paid for, and the reimbursement is at risk over paperwork. This shows up as CO-197, and preventing it means obtaining and continuously matching authorization across the treatment plan. Our team manages authorization at the regimen level so a cycle change doesn't quietly invalidate the approval on file.
Around the drugs sits everything else: diagnosis-driven medical necessity (a CO-50 on an oncology claim is expensive to appeal and expensive to lose), the E/M visits that plan and monitor treatment (leveled defensibly with our E/M code calculator), hematology services and blood-product administration, and coordination with specialty pharmacy for oral oncolytics. Because every dollar matters at oncology scale, we track the practice's denial rate and route the high-dollar denials through structured denial management — one recovered oncology claim can outweigh a month of small-dollar wins.
These are 2026 national Medicare rates from the CMS fee schedule. Your local rate is a little higher or lower, and many commercial contracts are priced as a percentage of Medicare, so this is a useful baseline when you review your own payments.
| Code | Service | Office | Facility or reading only |
|---|---|---|---|
| 96413 | Chemotherapy infusion, first hour | $133.27 | Billed by the facility |
| 96415 | Each extra hour (add-on) | $28.39 | Billed by the facility |
| 96417 | Each extra sequential drug infusion (add-on) | $66.47 | Billed by the facility |
| 96409 | Chemotherapy IV push, first drug | $104.54 | Billed by the facility |
| 96401 | Chemotherapy injection under the skin or into a muscle | $71.81 | Billed by the facility |
| 96360 | IV hydration, first hour | $33.40 | Billed by the facility |
| 99215 | Established patient visit, high | $192.39 | $125.59 |
Bill one initial administration code per visit, then add-ons. Drugs are billed separately with J-codes, and Medicare pays most of them at average sales price plus 6 percent.
Free one-week audit. We review a week of your claims, denials and open prior authorizations, and show you where money is being lost.
Free one-week trial. We work your oncology claims for a week, so you can see the process before you sign anything.
Simple pricing. Most practices pay a percentage of what we actually collect, typically 4–7% of net collections. Flat-rate pricing is also available.
Specialties tied to oncology by diagnosis, imaging, infusion coding or reconstruction.
Diagnostic imaging and radiation oncology both attach to the cancer episode, each with distinct coding.
GI cancers are found and surveilled endoscopically, linking the two along the whole pathway.
Both run high-cost infusion suites, sharing J-code buy-and-bill and prior-authorization problems.
Post-mastectomy and post-resection reconstruction is billed as medically necessary, not cosmetic.
Lung cancer screening and diagnosis run through pulmonology before oncology takes over.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Get a free billing audit and see how much more your oncology practice can collect and protect.
Get Free Practice AuditFree resources: CO-197 — Authorization | CO-151 — Units/Frequency | Denial Rate Calculator | Denial Management