Oncology billing is drug-heavy, with infusion timing, drug units and waste that all drive payment.
Examples of frequently billed services, with billing notes from our coders.
| CPT code | Service | Billing note |
|---|---|---|
| 96413 | Chemotherapy infusion, up to 1 hour | Need documented start and stop times |
| 96415 | Chemotherapy infusion, each added hour | Add-on to the first hour |
| 96365 | Therapeutic infusion, first hour | Not for chemo drugs |
| 96401 | Chemotherapy injection, subcutaneous or IM | Non-hormonal anti-cancer drugs |
| 77385 | Intensity-modulated radiation delivery | Bundles with treatment planning rules |
| 77427 | Radiation treatment management, weekly | Billed per five fractions |
| J9999 | Not otherwise classified cancer drug | Needs NDC, units and documentation |
Codes shown are common examples and descriptions are simplified in our own words. CPT® is a registered trademark of the American Medical Association. Always confirm against the current AMA CPT codebook, ICD-10-CM and each payer’s policy.
Modifiers tell the payer how and why a service was performed. Missing or wrong ones are a leading cause of denials.
Eligibility, benefits and prior authorization verified before the visit.
Code, modifier and documentation review before claims are submitted.
Denials corrected and appealed, aging claims worked until resolved.
Diagnostic testing, procedures and E/M claims coded correctly for each payer.
View billing detailsBiopsy, lesion removal and Mohs billing, with medical and cosmetic claims kept separate.
View billing detailsColonoscopy, endoscopy and screening claims coded for the right site and payer.
View billing detailsTalk to our team about your practice, hospital or lab. We will review your current billing and show you where revenue is slipping away.