Oncology Medical Billing and Coding Services
Oncology billing is one of the most complex areas in healthcare. Constant updates to ICD-10, CPT, and HCPCS codes, high-cost chemotherapy and infusion drugs, and payer-specific prior authorization rules put revenue at risk. Even one denied infusion claim or missed modifier can cost thousands in lost reimbursement.
Preferred MB delivers oncology medical billing services designed to cut denials, speed up payments, and keep your practice compliant with the latest CMS and commercial payer rules.
- 20% Average Denial Reduction
- 97%+ First-Pass Clean Claim Accuracy
- 25 Days in AR (Oncology Benchmark Leading)
Why Oncology Billing is the Most Demanding Specialty
Oncology medical billing services face some of the toughest challenges in healthcare. Between fast-changing coding updates, high-cost drugs, and multi-disciplinary treatment plans, practices are left exposed to frequent denials and delayed reimbursements. Without specialized oncology billing support, even a small coding slip can disrupt cash flow.
Common Oncology Billing Challenges
- Chemotherapy and infusion drug claims denied due to incorrect J-code mapping
- Radiation oncology procedures flagged for incomplete documentation or treatment planning notes
- Multi-specialty oncology cases (surgical + medical + radiation) denied for coding overlap
- Payers rejecting claims when prior authorization rules for high-cost therapies aren’t followed
- Denials are left unresolved when the billing staff can’t keep up with oncology-specific payer logic
Risks We Track for Oncologists
- Incorrect drug dosage coding and infusion time calculation
- Bundled code errors on chemo and radiation services
- Prior authorization delays for immunotherapy and biologics
- Over-coding or under-coding that threatens compliance
- AR days are ballooning due to abandoned soft denials
- Missed billing for supportive oncology services (hydration, antiemetics, pain management)
Preferred MB ensures your oncology billing process is accurate, compliant, and revenue-focused — so every service you deliver is reimbursed on time.
Our Specialized Oncology Billing Services
Oncology billing isn’t generic medical billing. Each cancer treatment — from chemotherapy infusions to radiation therapy — comes with strict coding, authorization, and documentation rules. Preferred MB delivers oncology medical billing services that align with payer logic, reduce denials, and protect your revenue cycle.
Here’s how we support oncology practices every day
Prior Authorization Handling
We secure pre-approvals for chemotherapy, immunotherapy, and specialty drugs so treatment can begin without reimbursement delays.
Oncology-Specific Coding
Our certified coders specialize in oncology billing, managing J-codes, infusion times, bundled CPTs, and diagnosis mapping to payer rules.
Denial Management & Appeals
We track every rejection, identify root causes, and pursue appeals aggressively — ensuring oncology claims don’t get lost in the system.
Drug Reimbursement Accuracy
High-cost oncology drugs require precise coding and documentation. We capture every unit, modifier, and NDC to maximize reimbursements.
Radiation Oncology Expertise
From treatment planning (77261–77299) to delivery codes (77401–77499), we submit clean claims with correct bundling and medical necessity checks.
Surgical & Multi-Specialty Oncology Billing
We coordinate billing across medical, surgical, and radiation oncology — preventing overlap errors and ensuring bundled rules are followed.
AR Recovery & Tracking
Every unpaid oncology claim is followed until resolved, reducing AR days and protecting cash flow.
Compliance & Reporting
Our oncology billing services include full transparency with reports on denial rates, AR aging, and payer-specific trends.
Prior Authorization is the #1 Barrier in Oncology Billing
Chemotherapy. immunotherapy. and radiation oncology services almost always require prior authorization. A single missed step can cause weeks of delays or complete claim denials. With drug costs in the thousands per dose, prior auth mistakes directly threaten the financial health of oncology practices.
Why Our Prior Authorization Workflow Wins:
- Proactive verification of chemotherapy and infusion drug approvals before treatment begins
- Automated tracking of payer-specific authorization timelines
- Documentation matched to medical necessity rules for every oncology drug and procedure
- Pre-submission validation for high-cost biologics and specialty therapies
- Dedicated oncology specialists following up with payers until approvals are secured
- Audit trail maintained for every authorization to prevent compliance risks
- Integration with your EHR to keep clinical and billing teams aligned
Preferred MB doesn’t just request prior authorizations — we ensure approvals are obtained, tracked, and documented, so claims are paid without interruption.
Is Prior Authorization Delaying Your Oncology Payments?
If you say “yes” to 2 or more, your billing team may be costing your practice thousands each month:
Not All Oncology Is the Same — Neither Is Our Billing
We tailor oncology medical billing services for chemotherapy, radiation, surgery, pediatrics, and gynecology — ensuring accurate coding, timely payments, and payer compliance.
Clinical Scenario
Patients receive multi-drug infusions with hydration and pre-medication.
- Infusion times logged in oncology EHR systems accurate
- Drug units mapped precisely to J-codes and NDCs
- Prior authorizations linked to treatment regimens before submission
Billing Scenario
Clean chemotherapy billing requires exact dosage capture and sequencing.
- CPT hierarchy applied to initial, sequential, concurrent infusions
- Modifiers checked for multi-drug administration in single session
- Claims scrubbed against payer-specific oncology drug rules
Clinical Scenario
Patients undergo treatment planning and daily radiation therapy sessions.
- Simulation completed with CT or MRI mapping
- Treatment plans documented and stored in oncology EHR
- Daily session notes verified for completion and compliance
Billing Scenario
Radiation billing requires correct planning and delivery code usage.
- CPTs 77261–77299 applied for simulation and planning
- CPTs 77401–77499 mapped to treatment delivery sessions
- Frequency checks aligned with payer policy and LCDs
Clinical Scenario
Patients undergo tumor resection with follow-up reconstructive care.
- Surgery performed by a multi-disciplinary oncology team
- Pathology results included in surgical documentation
- Post-op recovery and follow-ups tracked in EHR
Billing Scenario
Surgical oncology billing requires multi-specialty alignment and coding.
- CPTs separated by procedure stage and provider specialty
- Modifiers used to resolve overlapping global service periods
- Bundling errors prevented with payer-specific coding logic
Clinical Scenario
Children treated for leukemia with chemo and biopsies.
- Weight-based dosing carefully logged for each patient
- Bone marrow biopsies documented with pathology reports
- Multi-provider care documented across inpatient oncology team
Billing Scenario
Pediatric billing requires accurate drug dosing and coordination.
- J-code units validated for pediatric-specific dosing rules
- CPTs applied for biopsy, chemo, and supportive services
- Claims scrubbed for inpatient vs outpatient duplication
Clinical Scenario
Patients undergo surgery and post-op radiation therapy care.
- Surgical procedures logged with lymph node dissections
- Radiation follow-ups tracked and sequenced in oncology EHR
- Supportive services documented for hydration and pain relief
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See all specialties we serve across medical billing and coding
Billing Scenario
Pediatric Gynecologic billing requires surgical and radiation sequencing accuracy. billing requires accurate drug dosing and coordination.
- CPTs sequenced correctly between surgical and radiation claims
- Modifiers applied to distinct but related oncology procedures
- Ancillary services are billed separately for maximum reimbursement
Our Work Across Oncology Practice Models
Each oncology setting carries unique billing risks — from multi-specialty coordination to payer-specific oncology drug edits. Here’s how Preferred MB supports every model.
Hospital-Affiliated Cancer Centers
Challenge: Multiple departments create coding overlaps and global period conflicts.
Solution: We align inpatient–outpatient oncology claims and scrub bundled codes to prevent denials across surgical, infusion, and radiation units.
Independent Oncology Practices
Challenge: Denials often occur when documentation fails to justify expensive oncology treatments.
Solution: We connect clinical notes to payer LCD logic, verify ICD links, and ensure chemotherapy and infusion claims are supported upfront.
Multispecialty Clinics with Oncology Departments
Challenge: Shared EHRs cause oncology CPTs to clash with other specialties.
Solution: We isolate oncology coding, monitor split-claim risks, and protect reimbursement from cross-specialty billing conflicts.
ASC-Based Oncology Units
Challenge: Site-of-service mismatches and modifier gaps impact infusion and radiation billing.
Solution: We validate service location, apply payer-specific edits, and split charges cleanly between facility and professional oncology components.
Practices After Vendor Change or Audit
Challenge: Old vendors leave unresolved oncology AR and compliance issues.
Solution: We recover unpaid claims, correct missed modifiers, and clean up coding errors that audits or prior billers overlooked.
Oncology Billing That Adapts to Every Payer’s Rules
Medicare enforces strict oncology coverage rules. Commercial carriers deny high-cost drug claims. Medicaid demands state-specific documentation. Preferred MB applies payer edits, rules, and timing logic — before your oncology claim is submitted.
- Capture chemotherapy and radiation services within CMS oncology coverage rules
- Track staging requirements for treatment planning and simulation services
- Ensure infusion units and J-codes align with approved LCD guidance
- Map provider documentation to Medicare oncology frequency rules
97%
Medicare oncology claims approved on first submission with compliance-based edits
- Navigate carrier-specific edits on biologics, immunotherapy, and imaging
- Separate infusion sessions and imaging charges to meet plan logic
- Apply correct modifiers for multi-drug regimens across payers
- Flag off-label oncology treatments for clinical justification before claim submission
95%
First-pass acceptance for chemotherapy and infusion claims across leading commercial payers
- Validate oncology services against state-specific program restrictions
- Secure prior authorization for chemo and specialty oncology drugs upfront
- Match ICD-10 cancer diagnoses to approved treatment conditions per state rules
- Resolve site-of-service conflicts between hospital oncology and outpatient care
94%
Approval success rate across oncology claims in state Medicaid programs
- Link oncology services to verified injury or causality reports
- Time-stamp treatments to match injury-related care protocols
- Avoid duplicate billing when oncology overlaps with trauma or surgical claims
- Document specialty services to align with workers’ comp coverage criteria
92%
Clean claim rate for oncology tied to verified injury-based approvals
Proof of Performance in Oncology Billing
Oncology practices need more than promises — they need evidence. Preferred MB delivers measurable results across clean claim rates, denial turnaround, and oncology-specific reimbursement metrics.
| Metric | Preferred MB Result | Impact for Oncology Practices |
|---|---|---|
| Clean Claim Rate | 97%+ on chemo & radiation claims | Fewer rejections. Faster payments |
| Denial Turnaround | < 14 days average resolution | Revenue recovered before it stalls |
| Accounts Receivable (AR) | Reduced from 40+ to < 25 days | Stronger cash flow & stability |
| Drug Billing Accuracy | 99% J-code & NDC match rate | Correct reimbursement for costly drugs |
| Revenue Recovery | $1,000–$1,500 per oncologist monthly | Captured missed charges & supportive services |
With Preferred MB, you don’t just outsource oncology billing — you gain a partner that proves performance in numbers.
Why Practices Choose Preferred MB
Certified oncology billers trained in chemotherapy, infusion, and radiation
- Faster claim approvals with payer-specific oncology edits
- Dedicated account managers for personalized support
- Transparent reporting with denial, AR, and revenue dashboards
- Proven outcomes: 97% clean claims and AR reduced below 25 days
Let’s Fix Your Oncology Billing Now
Book your free oncology billing consultation and see how Preferred MB can increase revenue, cut denials, and give your team time back for patient care.