Medical Billing for Oncology & Hematology Practices

Oncology Billing That Pays What You Earn

Oncology billing is among the highest-stakes in medicine: chemotherapy administration codes, expensive drug passthrough billing, clinical trial billing restrictions, and the sheer complexity of multi-drug regimen coding all create enormous revenue risk. A single miscoded infusion visit can cost thousands. 360Solutions provides oncology billing specialists who manage chemotherapy drug billing, infusion time tracking, clinical trial coordination, and radiation therapy coding with the precision that cancer care demands.

$2,800
avg revenue per chemo infusion visit correctly coded
33%
avg oncology claims denied on first submission nationally
24h
drug billing reconciliation turnaround
Oncology Billing Challenges
Where practices lose the most revenue:
Chemotherapy Infusion Coding
Drug Passthrough Billing
Clinical Trial Billing
Prior Auth for Biologics
Oncology Billing Challenges

Where Oncology Practices Lose Revenue

These are the coding and billing pitfalls that cost oncology practices the most — and where our specialised billers add the most value.

Chemotherapy Infusion Coding

Chemotherapy infusion codes (96401–96417) are time-based and drug-type specific — push vs. infusion, initial vs. sequential. Each drug in a multi-drug regimen must be coded separately with the correct add-on code. Missing an add-on costs $150–400 per visit.

Drug Passthrough Billing

Chemotherapy drugs are billed at Average Selling Price (ASP) + 6% under Medicare. Commercial payers have varying drug coverage and markup policies. We verify drug codes (J-codes), units, and NDC numbers against pharmacy records before every claim.

Clinical Trial Billing

Patients on clinical trials require careful separation of routine care (billable) from research-specific services (non-billable). Incorrect billing to insurance for trial-covered services triggers False Claims Act exposure. We maintain trial billing protocols.

Prior Auth for Biologics

Targeted therapies, immunotherapy agents, and biosimilars require step therapy documentation and prior auth from nearly every payer. We manage the auth lifecycle — from initial request through appeals — to prevent drug administration delays.

Coding Intelligence

High-Risk CPT Groups

Code ranges payers audit most aggressively in Oncology.

96401–96402
Chemotherapy injection — non-hormonal / hormonal agent
96409–96417
Chemotherapy infusion — push, initial, sequential, concurrent add-ons
77300–77336
Radiation therapy — treatment planning, simulation, IMRT
96360–96368
Hydration and non-chemo therapeutic infusion — initial and sequential
J-codes
Drug billing — ASP-based chemotherapy and biologic agent J-codes
Denial Intelligence

Common Denial Patterns

Knowing these before submission is the difference between a 60% and a 96% first-pass rate.

Chemotherapy add-on code billed without corresponding primary infusion code

Drug J-code units do not match pharmacy dispense record

Clinical trial service incorrectly billed to insurance (non-billable trial protocol)

Prior auth for biologic agent obtained for wrong indication or dose

Radiation treatment planning code billed without documented dosimetry calculation

Free Denial Audit

Send us your last 90 days of remittance data — we'll identify your top 3 fixable denial sources at no cost.

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Our Process

How 360Solutions Works for Oncology Practices

01

Free 2-Week Billing Audit

We review your last 90 days: denial breakdown by category, AR aging by payer, charge lag, collection rate, and any recurring coding issues specific to your specialty. No commitment required.

02

Specialty Coder Assignment

You are paired with a coder trained specifically in oncology coding. They learn your providers, your documentation patterns, and your payer mix before touching a claim.

03

Parallel Billing Transition

We run alongside your current billing for 10–14 days with zero cash flow disruption. Claims keep moving during the transition. Your account manager provides daily status updates.

04

Live KPI Dashboard

Real-time visibility into billed, paid, denied, AR aging, and collection rate — segmented by provider and payer. No black box, no month-end surprises.

05

Weekly Account Manager Call

Every week your dedicated account manager walks through last week's KPIs, denial trends, and any action items. Critical issues are escalated the same day — not at the next scheduled call.

Oncology Billing FAQ

Questions From Oncology Practices

We receive a daily or weekly pharmacy dispense report and reconcile it against the charge master. Any discrepancy in J-code, units, or NDC triggers a hold until resolved. This process prevents the audit risk of billing drugs that were not administered.
Yes. We manage distinct billing workflows for medical oncology (infusion/drug billing) and radiation oncology (treatment planning, delivery, and physics QA codes) — including the technical and professional component splits for hospital-based radiation.
CAR-T therapy is among the most complex auth processes in medicine. We coordinate with the specialty pharmacy, the payer's specialty tier, and the hospital billing team to obtain auth, manage site-of-service requirements, and bill the infusion correctly.
Yes. Molecular pathology codes (81162–81383) and multi-gene panel codes (81410–81411) require specific ICD-10 diagnoses for medical necessity. We verify coverage and submit with required genetic counselling documentation where needed.
Ready to Fix Your Oncology Billing?

Start With a Free,
No-Obligation Audit

Two weeks, no contract. A certified oncology billing specialist reviews your claims, denial patterns, and AR — and shows you exactly what is recoverable.