Oncology Billing Services
Oncology Billing Services That Protect High-Value Cancer Care Revenue
Oncology billing is among the most complex and highest-stakes in medicine: high-cost chemotherapy drug claims, infusion time documentation, cancer staging specificity, prior authorization on every major treatment, and multi-disciplinary bundling rules create constant revenue risk. ProtoMed's certified oncology billing specialists ensure every claim is coded precisely and submitted compliantly. Fewer denials. Faster reimbursements. More revenue.
98%+
Clean Claim Rate
Every oncology claim reviewed before submission. Drug administration unit errors, infusion time gaps, and authorization mismatches caught before they reach the payer.
Why Choose Us
Stop Losing Oncology Revenue to Coding Errors on High-Cost Claims
Oncology billing combines the highest claim values in medicine with the most complex coding requirements. A single chemotherapy claim can involve drug administration codes, infusion time add-ons, drug J-codes, and hydration billing, all of which must be documented to the minute, coded to the correct HCPCS drug code, and submitted with prior authorization confirmation. A single miscoded drug administration unit or a missing cancer staging diagnosis code can mean the entire high-value claim is denied. When claims routinely exceed $10,000–$50,000, billing errors are not inconveniences. They are major revenue losses.
ProtoMed's certified oncology billing team handles the full complexity of cancer care billing, from chemotherapy and infusion administration coding and radiation oncology complexity-level documentation to surgical oncology bundled procedure claims and immunotherapy prior authorization management. We submit clean claims, secure pre-authorizations for every major treatment, and appeal every denial with the clinical documentation payers require.
Certified Oncology Billing Specialists
Every biller on your account holds active AAPC and AHIMA credentials with hands-on experience in oncology CPT, HCPCS drug coding, ICD-10 cancer staging specificity, and payer-specific authorization requirements.
98%+ Clean Claim Rate
We review every claim before submission, catching drug administration unit errors, infusion time documentation gaps, incorrect cancer staging codes, authorization mismatches, and bundling conflicts before they reach the payer.
Zero-Friction Access
We securely log into your existing EHR: Epic, eClinicalWorks, Athenahealth, and more, with zero disruption to your clinical schedule or infusion workflow.
End-to-End Claims Management
From insurance verification and prior authorization to claim submission, denial appeals, and payment posting, we manage your complete oncology billing cycle.
Proactive Denial Management
Every rejected claim is investigated, corrected, and resubmitted with the clinical documentation required for a successful appeal, including medical necessity disputes on high-cost chemotherapy and immunotherapy claims.
Transparent Financial Reporting
Monthly reports and real-time billing data give you a clear picture of your collections, authorization approval rates, drug-specific reimbursement performance, and denial patterns by payer.
Our Expertise
Oncology Coding Expertise That Reduces Denials
Oncology billing spans chemotherapy drug administration, radiation therapy, surgical oncology, infusion services, and diagnostic imaging, each with distinct HCPCS drug codes, CPT administration codes, cancer staging ICD-10 specificity requirements, and payer authorization rules. Our certified coders know every code across the full cancer care spectrum.
CPT 96413–96417
IV chemotherapy administration: initial hour and each additional hour add-on coding
CPT 96365–96368
Non-chemotherapy infusion: therapeutic drug administration with add-on hour coding
HCPCS J-codes
Chemotherapy and immunotherapy drug billing: drug-specific J-codes with wastage documentation
CPT 77427 / 77336
Radiation oncology: treatment management and stereotactic radiosurgery complexity coding
CPT 88305 / 88307
Surgical pathology: biopsy and cancer specimen coding with complexity level selection
ICD-10 C00–D49
Cancer staging specificity: primary site, histology, laterality, and encounter type coding
CPT 78816 / 71250
Diagnostic imaging: PET/CT, MRI, and nuclear medicine with radiopharmaceutical billing
Procedure-Specific Services
Specialized Billing for Every Oncology Service
Each oncology service category carries enormous claim value and its own coding complexity. A single billing error on a chemotherapy administration claim or a missed prior authorization on an immunotherapy infusion can represent thousands of dollars in lost revenue. ProtoMed's certified team gets every claim right the first time.
Chemotherapy Administration Billing
Chemotherapy infusion billing requires precise time-based coding for each drug administered, correct sequencing of initial and add-on hour codes, separate drug billing using payer-specific J-codes, and accurate documentation of drug wastage. When multiple drugs are given in sequence, the infusion hierarchy rules determine which receives the initial code and which become add-ons. We code every chemotherapy encounter with the unit-level accuracy that high-cost drug claims demand.
Immunotherapy & Targeted Biologic Billing
Immune checkpoint inhibitors, monoclonal antibodies, and targeted therapies are among the highest-value claims in oncology, and they require prior authorization, drug-specific J-codes, accurate infusion administration coding, and toxicity monitoring documentation. A single authorization gap or incorrect drug code on an immunotherapy claim can delay treatment and deny thousands of dollars. We manage the complete immunotherapy billing lifecycle from pre-authorization through final payment.
Radiation Oncology Billing
CMS has restructured radiation oncology codes into complexity-level tiers, and commercial payers are applying strict criteria to determine which tier applies. Simulation, treatment planning, IMRT, SBRT, and stereotactic radiosurgery all require procedure-specific documentation that supports the complexity level billed. We ensure every radiation treatment claim is coded to the correct complexity level with the clinical documentation needed to withstand payer review.
Surgical Oncology Billing
Surgical oncology claims combine high-value procedure codes with complex multi-specialty documentation requirements. Lymphadenectomy add-ons, pathology coordination, reconstructive procedure billing, and post-operative care bundling all affect reimbursement. Bundled surgical claims must include every service performed while correctly separating non-bundled services that are separately billable. We capture every component of surgical oncology encounters and prevent revenue loss from incorrect bundling.
Prior Authorization Management
Prior authorization is required for nearly every high-cost oncology treatment. Chemotherapy regimens, immunotherapy, advanced imaging, and radiation therapy all require payer approval before treatment can begin. A missed or expired authorization means a denied claim on claims that may exceed $50,000. We manage the complete prior authorization lifecycle for oncology treatments: building evidence-based clinical summaries, tracking payer timelines, and ensuring every treatment has confirmed authorization before it is administered.
Diagnostic Imaging Billing
PET scans, CT, MRI, and nuclear medicine studies are critical to cancer staging, treatment planning, and response assessment, and each requires precise CPT and radiopharmaceutical code selection, medical necessity documentation, and payer-specific prior authorization. We accurately code every oncology imaging encounter, manage authorization requirements, and coordinate the professional and technical component billing for studies performed in your facility versus external imaging centers.
How It Works
How ProtoMed's Oncology Billing Process Works
A structured four-step process that protects high-value cancer care revenue at every stage, from pre-authorization and insurance verification through final payment posting on every claim.
Practice Audit & Revenue Gap Analysis
We review your current oncology billing setup, identify revenue leaks from drug administration unit errors, missed infusion add-on codes, authorization failures, and unresolved denials, then securely access your existing EHR with zero disruption to your clinical and infusion operations.
Eligibility Verification & Prior Authorization
Before each treatment, we verify patient coverage, confirm payer-specific drug and treatment coverage, and obtain prior authorizations for chemotherapy regimens, immunotherapy, advanced imaging, and radiation therapy. Securing authorization before treatment begins eliminates the most preventable and costly source of oncology claim denials.
Claim Coding, Scrubbing & Payer Submission
Our certified oncology coders review every encounter, apply the correct CPT and HCPCS drug codes, document infusion time and drug wastage accurately, and apply cancer staging ICD-10 codes with full specificity. Every claim is scrubbed against payer-specific rules before submission to Medicare, Medicaid, Medicare Advantage, and all major commercial payers.
Denial Management, Payment Posting & Reporting
Every denied claim is appealed with clinical documentation, including medical necessity letters for high-cost drug denials, and root-cause analysis to prevent recurrence. Payments are posted accurately against expected contract rates, underpayments are flagged, and you receive clear monthly reports on collections, drug-specific reimbursement performance, and denial patterns by payer.
Ready to Protect Your Oncology Practice Revenue?
Let ProtoMed's certified oncology billing specialists handle your complete revenue cycle, from chemotherapy drug coding and infusion time documentation to immunotherapy authorization management, radiation oncology complexity-level billing, and denial appeals on high-value cancer care claims. We'll audit your current billing, identify where revenue is being lost, and start recovering it.
Get your free oncology billing audit today. A ProtoMed expert will reach out within 24 hours.