Oncology Medical Billing Services

Oncology medical billing follows strict CMS, Medicare, Medicare Advantage, Medicaid, and commercial payer guidelines. Oncologists providing services such as chemotherapy, infusion therapy, radiation therapy, surgical oncology, immunotherapy, and supportive care must work within payer rules that directly affect coding accuracy, documentation, modifier use, and reimbursement timelines.

MZ Medical Billing manages the complete oncology revenue cycle, including patient eligibility verification, charge entry, coding review, electronic claim submission, ERA/EOB reconciliation, payment posting, denial correction, and accounts receivable follow-up.

Each step is performed according to Medicare, Medicaid, and commercial payer requirements, with processes designed for practices managing high-cost treatments and complex multi-specialty care.

Billing for oncologists involves daily coordination with Medicare Administrative Contractors (MACs), Medicare Advantage plans, state Medicaid oncology programs, and commercial insurers. Claims are reviewed for chemotherapy regimen compliance, infusion documentation, radiation planning, surgical oncology coding, drug wastage reporting, prior authorization requirements, and payer-specific coverage rules to reduce claim rejections.

Our internal audits identify documentation gaps, CPT/ICD-10 mismatches, HCPCS and J-code errors, incorrect modifier usage (e.g., -JW, -59, -76), missing prior authorizations, and underpaid claims. Denials are corrected and resubmitted according to payer timelines, and aging accounts are monitored to maintain steady cash flow.

Oncology practices and oncologists working with MZ Medical Billing typically see 95–97% first-pass claim resolution rates, 96–98% claim approval rates, and accounts receivable averages of 25–30 days across Medicare, Medicaid, and commercial insurance plans. These results reflect precise coding for chemotherapy, radiation, and surgical procedures, complete documentation, correct modifier application, and careful adherence to oncology-specific payer rules.

By handling complex oncology billing workflows, MZ Medical Billing helps cancer care providers secure faster payments, reduce denials, ensure compliance, and focus on patient care rather than administrative burden.

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Oncology Medical Billing Services You Can Trust

Oncology practices face some of the highest administrative and financial challenges in healthcare. Beyond the complexity of treatments, providers must deal with rising drug costs, payer policy shifts, evolving coding guidelines, and value-based care initiatives that demand accurate reporting and compliance. Managing these requirements in-house often strains staff resources and increases the risk of audit exposure, delayed reimbursements, and lost revenue.

MZ Medical Billing supports oncologists, hematologists, infusion centers, and cancer treatment facilities with end-to-end billing expertise. Our team applies specialty-driven workflows, advanced oncology billing software, and payer-specific compliance checks to keep claims accurate, denials low, and revenue consistent. By outsourcing oncology billing to us, practices gain a partner that understands both the clinical complexity of cancer care and the financial pressures of modern healthcare—allowing providers to focus on patients while we safeguard the revenue cycle.

Below, we’ve outlined the specialized oncology medical billing services we provide to strengthen your practice’s financial performance.

Medical Billing Services

We manage the complete oncology billing cycle, from charge entry and claim submission to payer follow-up. Oncology involves highly complex codes for chemotherapy administration, infusion services, radiation therapy, laboratory testing, imaging, and cancer-specific treatments. Our billing process follows payer-specific rules, including Medicare Local Coverage Determinations (LCDs), NCDs, and commercial payer oncology policies to minimize denials and speed up reimbursements.

Medical Coding Services

Our certified coders specialize in oncology coding, covering chemotherapy infusion codes, hydration therapy, radiation therapy, hematology/oncology E/M services, bone marrow transplants, and palliative care. Proper modifier usage (e.g., -59 for distinct services, -JW for drug wastage, and -25 for E/M with infusion) is applied to ensure compliance and maximum reimbursement.

Provider Credentialing Services

Oncology practices cannot bill without proper enrollment. We handle Medicare, Medicaid, and commercial payer credentialing, update CAQH profiles, and maintain provider records. This allows oncologists to remain active with payers and prevents costly billing delays.

Practice Audit Services

Oncology claims are closely scrutinized by payers due to high-cost drugs and treatments. We audit chemotherapy billing, drug wastage reporting, infusion time coding, modifier use, and prior authorization documentation. Our audits uncover underbilling, compliance risks, and opportunities to capture missed revenue.

Revenue Cycle Management (RCM)

We oversee the oncology revenue cycle, from benefit verification and claim submission to payment posting and A/R follow-up. This includes drug acquisition cost management, J-code billing, prior authorizations, and payer-specific oncology coverage policies. Strong RCM ensures faster reimbursements and steady practice cash flow.

Insurance Verification Services

Oncology patients often face complex insurance rules with Medicare, Medicaid, and commercial plans. We verify chemotherapy and infusion coverage, diagnostic imaging benefits, prior authorization requirements, and specialty pharmacy rules, helping patients understand financial responsibility upfront while preventing rejections.

Prior Authorization Services

Many oncology services require prior authorization, including chemotherapy, radiation therapy, PET scans, genetic testing, and specialty drug infusions. We gather medical records, submit documentation, and follow up with payers to secure approvals quickly and avoid treatment delays.

Denial Management

Oncology claims are often denied due to incorrect J-code billing, drug wastage errors, lack of prior authorization, or medical necessity issues. We analyze denial patterns, correct and resubmit claims, and file appeals with strong clinical documentation to recover revenue.

Payment Posting

Oncology billing involves multiple high-value services and drugs. We post payments accurately, reconcile ERAs and EOBs, and flag underpayments or bundling errors for immediate follow-up.

Accounts Receivable (AR) Recovery

Outstanding oncology claims often result from payer disputes, prior authorization lapses, or drug wastage documentation errors. We work aged A/R, resubmit claims where possible, and pursue appeals to recover delayed payments.

Telehealth Billing

Oncologists increasingly use telehealth for follow-ups, medication management, genetic counseling, and palliative care. We apply the correct place-of-service codes (02, 10) and telehealth modifiers (95, GT) to secure full reimbursement.

Patient Billing Services

Cancer treatments involve complex costs that can overwhelm patients. We provide clear patient statements, explain coverage differences (chemotherapy vs. supportive care), and offer payment plan options—improving collections and supporting patients through difficult times.

Practice Management Services

We help oncology practices with performance tracking, payer mix analysis, denial trends, and drug utilization reports. These insights strengthen financial performance and help practices manage operational challenges.

Old AR Cleanup

Oncology practices often have aging A/R due to chemotherapy billing errors, specialty drug claims, or disputed medical necessity. We review old claims, correct issues, and resubmit where possible to recover revenue from aged accounts.

Appeals and Disputes Management

Oncology claims are frequently denied due to drug wastage documentation, prior authorization issues, or payer-specific bundling rules. Our team prepares strong appeals with infusion records, clinical notes, and coding justification to overturn denials and secure reimbursement.

Why Outsource Oncology Billing and Collections Services to MZ Medical Billing

Oncology practices need more than claim submission—they need a partner who understands the financial, regulatory, and operational pressures of cancer care. Outsourcing oncology billing and collections to MZ Medical Billing helps practices streamline operations, reduce compliance risks, and unlock the resources needed to focus fully on patient outcomes.

Compliance and Regulatory Safeguards

Oncology billing is subject to strict oversight under Medicare, Medicaid, and commercial carriers. We stay current with evolving rules on chemotherapy wastage reporting, infusion documentation, and oncology care model (OCM/OCRE) compliance. Our proactive compliance checks help protect practices from audits, penalties, and revenue loss.

Advanced Reporting and Analytics

We provide actionable financial insights, including denial trend analysis, payer performance metrics, and treatment profitability reporting. These analytics help oncology practices make informed decisions about resource allocation, payer negotiations, and long-term financial planning.

Scalable Support for Growing Practices

As oncology practices expand services such as infusion suites, radiation therapy, or clinical trials, billing needs become more complex. Our team scales with your growth, handling increased patient volume, multi-location practices, and subspecialty services without interruptions in cash flow.

Reduced Administrative Burden

Outsourcing eliminates the need to manage in-house billing staff, ongoing coder training, and expensive billing software. Our specialists handle the full process, reducing overhead costs while improving efficiency. This frees up your internal team to concentrate on patient care, scheduling, and practice operations.

Stronger Financial Stability

With accurate collections, improved reimbursement timelines, and reduced write-offs, outsourcing strengthens cash flow and ensures steady financial stability—essential for practices delivering high-cost, life-saving oncology treatments.

Key Oncology Billing Compliance Factors

CPT/HCPCS Codes: Chemotherapy administration, infusion services, radiation therapy, and oncology surgery codes must align with payer policies.
ICD-10 Codes: Cancer diagnoses (e.g., C00–C97) must be accurately linked to procedures and treatment plans for medical necessity validation.
Modifier Use: Oncology-specific modifiers such as -JW (drug wastage), -59 (distinct procedures), and -25 (E/M with same-day chemo/infusion) are critical for compliance.
Drug Wastage Reporting: CMS requires detailed documentation and billing of unused chemotherapy drugs using the -JW modifier.
Prior Authorizations: Most chemotherapy regimens, radiation treatments, and advanced oncology procedures require payer approval before initiation.
Medical Necessity: Documentation must reflect cancer stage, treatment protocol, and clinical justification for every service billed.
Clinical Documentation Standards: Progress notes, infusion logs, dosage details, and pathology/lab reports must be complete to withstand audits.
Frequency & Bundling Rules: Adherence to payer-specific frequency limits and bundling edits for chemotherapy, radiation, and supportive drugs.

MZ Billing’s Oncology Billing & Coding Services with Proven Outcomes

Proven Results in Oncology Billing

We consistently deliver measurable financial improvements for oncology practices through specialty-specific billing workflows, drug wastage reporting, and payer-focused coding strategies.

Dedicated Oncology Billing Specialists

Our certified oncology coders and revenue cycle experts are trained in chemotherapy, infusion, and radiation billing. They manage complex oncology claims with precision to safeguard revenue against denials and compliance risks.

Oncology-Specific Technology

We utilize advanced oncology billing tools integrated with EMRs and oncology practice management systems. These solutions track chemotherapy regimens, infusion logs, and wastage reporting in real time, cutting down on rejected or delayed claims.

End-to-End Revenue Cycle Management

Beyond claims and coding, our services cover credentialing, payer enrollment, prior authorization support, contract negotiation, and appeals. We work with oncology clinics, cancer centers, and hospital-based programs of every size.

Transparent Reporting & Insights

We provide oncology practices with detailed monthly reports on drug reimbursements, infusion chair utilization, denial trends, and payer performance. This data helps practices make informed financial and operational decisions.

Measurable Performance Outcomes

Claim Turnaround: Average claim turnaround within 48–72 hours
Clean Claim Rate: ≥95% across chemotherapy, infusion, and radiation services
Patient Collections: 30–40% improvement with automated statement systems
Drug Reimbursement: Up to 98% recovery of contracted drug costs
Denial Reduction: Oncology-specific denials lowered to ≤6%
A/R Days: Reduced to 25–28 days on average
Revenue Growth: Practices outsourcing to us typically see 10–15% higher net collections compared to in-house billing

Common Medical Codes in Oncology Billing

Accurate coding is the backbone of successful oncology billing. With a combination of chemotherapy administration, infusion services, radiation therapy, and oncology surgeries, correct use of CPT, ICD-10, and HCPCS modifiers is critical. Even minor coding mistakes can trigger denials, underpayments, or payer audits. Our certified oncology coders specialize in cancer-specific billing rules, ensuring accurate claims and optimized reimbursement.

CPT Codes for Oncology

Oncology involves a wide spectrum of CPT and HCPCS codes covering drug administration, infusions, radiation, and surgical oncology:

96401–96417: Chemotherapy administration (IV push, infusion, prolonged services)
96360–96375: Hydration and therapeutic/prophylactic infusions
77401–77427: Radiation therapy delivery and management
77300–77334: Radiation treatment planning and dosimetry
19260–19298: Mastectomy and breast procedures
44140–44147: Colectomy and colorectal cancer procedures
32663: Thoracoscopy with lobectomy (lung cancer surgery)
36591–36598: Central venous access device (port) care and removal
J Codes (e.g., J9190, J9265, J9355): Chemotherapy drugs (fluorouracil, paclitaxel, trastuzumab)
C Codes (e.g., C9399, C9487): Outpatient hospital-administered oncology drugs

Our team applies bundling and wastage rules correctly (e.g., -JW modifier) and ensures payer-specific drug billing requirements are met.

ICD-10 Codes for Oncology

Diagnosis coding in oncology establishes medical necessity for drug administration, imaging, and surgical procedures. Examples include:

C50.0–C50.9: Malignant neoplasm of breast
C18.0–C18.9: Malignant neoplasm of colon
C34.0–C34.9: Malignant neoplasm of bronchus and lung
C61: Malignant neoplasm of prostate
C91.0–C95.9: Leukemia codes
C81–C86: Lymphoma codes
D46.0–D46.9: Myelodysplastic syndromes
C79.31 / C79.32: Brain metastases
C78.7: Secondary malignant neoplasm of liver
Z51.11 / Z51.12: Encounters for chemotherapy and immunotherapy
Z92.21 / Z92.3: Personal history of chemotherapy or radiation therapy

Every oncology claim must link CPT/HCPCS services to accurate ICD-10 cancer diagnoses to comply with payer requirements.

Modifiers in Oncology Billing

Modifiers play a vital role in capturing the complexity of oncology treatments, drug wastage, and concurrent therapies:

-JW: Drug wastage (unused portion of single-use vials)
-JZ: Zero wastage (required by CMS for unused drugs)
-25: Significant, separately identifiable E/M service on same day as chemotherapy/infusion
-59: Distinct procedural service (e.g., concurrent infusions not bundled)
-76 / -77: Repeat procedure or service by same/different physician
-KX: Documentation on file supporting medical necessity
-GY / -GA: Non-covered services with ABN issued
-XE / -XS / -XP / -XU: Distinct procedural services under CMS X-modifiers (often used in oncology infusions)
-RT / -LT: Laterality for radiation or surgical oncology

Correct application of these modifiers prevents denials, ensures compliance with Medicare and commercial payer rules, and safeguards oncology practice revenue.

Oncology Billing & RCM Services for Practices Nationwide

MZ Medical Billing provides specialized oncology billing and Revenue Cycle Management (RCM) services to practices across the United States. We work with oncologists, hematologists, cancer treatment centers, and infusion clinics to streamline reimbursements, reduce denials, and safeguard financial performance.

Our billing experts manage the unique complexities of oncology care, including chemotherapy and infusion billing, drug wastage reporting, radiation oncology coding, prior authorizations, payer-specific bundling rules, and strict compliance regulations. From E/M visits and infusion services to advanced therapies and palliative care, we ensure every claim is coded and submitted accurately.

With MZ Medical Billing, oncology practices benefit from clean claims, quicker reimbursements, and reduced revenue leakage—helping providers concentrate fully on patient care while we handle the financial and compliance challenges behind the scenes.

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Medical Billing Services for Oncology and Other Specialties

Our oncology billing specialists deliver precise, compliant solutions built for the complexity of cancer care. From chemotherapy and infusion billing to radiation oncology, hematology, and palliative services, we manage coding accuracy, clean claim submission, and full revenue cycle support to strengthen cash flow and reduce denials.

Along with oncology, we provide billing for other specialties including orthopedics, cardiology, chiropractic, physical therapy, occupational therapy, speech therapy, mental health, family medicine, and dermatology—offering each provider specialty-specific billing that fits their practice.

Applied Behavior Analysis

Behavioural Health

Pediatric

Mental Health

Physical Therapy

Occupational Therapy

Speech Therapy

Anesthesiology

FAQS

Frequently Asked Questions.

What is oncology medical billing?

Oncology medical billing is the process of coding, submitting, and managing insurance claims for cancer-related treatments such as chemotherapy, radiation therapy, infusion services, and surgical oncology. It requires accurate use of CPT, ICD-10, and HCPCS codes, plus detailed drug wastage reporting.

Why is oncology billing more complex than other specialties?

Oncology billing is complex because treatments involve high-cost chemotherapy drugs, strict prior authorization rules, detailed documentation requirements, and payer-specific bundling edits. Even small errors can lead to large financial losses.

What services are included in oncology billing?

Oncology billing covers chemotherapy and infusion coding, radiation therapy billing, prior authorization management, insurance verification, drug wastage reporting, denial management, A/R follow-up, and patient billing.

What coding systems are used in oncology billing?

Oncology billing uses a combination of ICD-10 codes (to describe cancer diagnoses), CPT/HCPCS codes (for chemotherapy, infusion, radiation, and surgery), and modifiers like -JW for drug wastage and -59 for distinct services.

Why is prior authorization important in oncology billing?

Most chemotherapy, radiation therapy, imaging, and specialty drug infusions require prior authorization. Without approval, claims are denied, causing treatment delays and financial risk.

What is the role of modifiers in oncology billing?

Modifiers communicate specific details about a treatment. For example:

-JW = unused chemotherapy drug wastage
-25 = E/M visit with infusion on same day
-59 = distinct procedures not bundled together
Correct use of modifiers is essential for compliance and full reimbursement.

How does outsourcing oncology billing help practices?

Outsourcing reduces administrative burden, lowers denial rates, speeds up reimbursements, and provides access to coders who specialize in oncology. This allows providers to focus on patient care instead of billing errors and audits.

What are common denial reasons in oncology billing?

Missing or incorrect prior authorization
Drug wastage not reported correctly
ICD-10 code not matching the treatment plan
Bundling errors with chemotherapy and infusion codes
Documentation gaps in infusion logs or progress notes

How do oncology billing specialists improve collections?

Specialists use oncology-specific billing software, conduct coding audits, track drug usage, and follow payer-specific policies. This leads to higher clean claim rates (95%+), faster reimbursements, and reduced A/R days.

Do you handle both hospital-based and private oncology practices?

Yes. MZ Medical Billing supports oncology clinics, infusion centers, cancer treatment facilities, and hospital-based oncology programs across the United States.