Oncology Billing Services
Oncology billing services are specialty billing and revenue cycle services built specifically for cancer care practices where a single undocumented drug wastage line, or one wrong unit on a high-cost immunotherapy J-code, is the difference between a fully paid claim and thousands of dollars quietly written off.
EverCure Billing handles the complete revenue cycle for oncology providers across the United States: eligibility checks, prior authorizations, chemotherapy and infusion coding, drug and administration billing, claim submission, denial appeals, and aged A/R recovery. Your team treats cancer. We make sure the work you already did and the drugs you already paid for actually get reimbursed.
What Are Oncology Billing Services?
Oncology billing services cover every financial step between a patient starting treatment and that money landing in your practice account.
For a cancer care practice specifically, that includes verifying benefits before a costly regimen begins, obtaining prior authorization for chemotherapy, immunotherapy, and advanced imaging, coding the drug and its administration with the correct J-code, unit count, NDC, and time-based infusion codes, documenting drug wastage, linking every service to the right cancer diagnosis and staging, submitting a clean claim, posting the payment, appealing the denial when the payer pushes back, and chasing the balance until it clears.
General medical billing stops at "submit the claim." Oncology billing has to go further, because oncology combines the highest drug costs in medicine with the strictest documentation rules and a single error is measured in thousands of dollars, not tens.
Why Do Oncology Practices Lose More Revenue Than Other Specialties?
Because oncology carries the most expensive drugs, the most time-sensitive authorizations, and the most detailed documentation rules in medicine and payers audit all three closely. These are the specific leaks we see when we run audits on oncology practices:
Drug wastage not documented correctly
When a single-use vial is opened and part of the drug is discarded, that discarded amount is billable but only with the correct wastage modifier and documentation, and payers now expect an indicator even when there's no wastage. On a high-cost drug, one missing wastage line is a large, unrecoverable loss.
Infusion time coding errors
Chemotherapy and therapeutic infusions follow a strict hierarchy initial, sequential, concurrent, and each-additional-hour with only one 'initial' per encounter. Get the hierarchy or the hour units wrong and the practice underbills its most valuable service of the day.
J-code, NDC, and unit mismatches
High-cost drug claims deny on drug-unit and NDC mismatches. On an inexpensive drug that's an annoyance; on an oncology drug, a single unit error swings the claim by thousands.
Prior authorization failures
Chemotherapy regimens, immunotherapy, targeted biologics, and advanced imaging almost always require authorization before treatment and treatment can't wait. No auth, no payment, and it usually can't be fixed after the fact.
Buy-and-bill and 340B handling
Practices that buy drugs and bill for them, or that participate in 340B, have to keep inventory, pricing, and billing indicators straight. Mixing them up is both a revenue problem and a compliance exposure.
Medical necessity and cancer staging gaps
Drug and imaging coverage policies require a documented diagnosis, staging, and the treatment-encounter code that supports medical necessity. If the note and the codes don't prove it, the claim doesn't hold up.
We build the workflow around these six failure points, because they are where oncology practice revenue actually disappears.
What Oncology Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
We verify active coverage, plan type, deductible status, coinsurance, and drug-specific benefits before treatment begins, and provide upfront financial counseling so a patient doesn't start a high-cost regimen under a plan that won't cover it.
Prior authorization support
We prepare and submit authorization requests for chemotherapy regimens, immunotherapy, targeted biologics, and advanced imaging, build the evidence-based clinical summary the payer needs, follow up until a decision is issued, and track expiry dates so approvals don't lapse before the treatment date.
Oncology medical coding
Our coders work from your treatment notes, infusion records, and pathology to assign the correct CPT, ICD-10-CM, and HCPCS codes with accurate drug units, NDCs, infusion time hierarchy, wastage documentation, cancer staging, and modifier set. Every code is tied back to what the documentation actually supports.
Charge capture and claim scrubbing
Every claim runs through a pre-submission check for payer-specific edits, drug-unit and NDC accuracy, infusion time logic, wastage indicators, diagnosis-to-drug linkage, and 340B or buy-and-bill flags before it leaves our office.
Claim submission and clearinghouse management
Electronic submission, rejection handling at the clearinghouse level, and same-day correction and resubmission on front-end rejects.
Payment posting and reconciliation
ERA and manual EOB posting, contractual adjustment verification, and underpayment identification critical in oncology, where a small percentage underpayment on a high-cost drug is real money most practices never catch.
Denial management and appeals
Every denial is categorized by root cause, corrected, and appealed with the supporting documentation the payer is actually asking for. We also feed denial patterns back into coding so the same denial stops repeating.
Accounts receivable follow-up and recovery
Structured follow-up on aged claims by bucket (30 / 60 / 90 / 120+ days), with priority given to high-dollar drug and infusion claims and anything approaching a timely filing deadline.
Patient billing and financial support
Clear patient statements, balance explanations, and support so your front desk isn't spending its day explaining coinsurance on expensive treatment.
Provider credentialing and payer enrollment
New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment through PECOS so a new oncologist in your group isn't sitting idle waiting on a payer panel.
Billing audits and compliance review
Periodic internal review of drug-unit accuracy, wastage documentation, infusion coding, 340B and buy-and-bill handling, and clinical trial billing to reduce audit exposure before a payer finds it first.
Financial reporting
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, drug-specific collections, and payer performance in plain language, not a data dump.
Which Oncology Procedures and Services
Do You Bill?
Chemotherapy administration intravenous infusion, IV push, and oral oncolytic dispensing, with correct infusion time hierarchy, drug units, and wastage documentation.
Immunotherapy immune checkpoint inhibitors, infusion administration, and the toxicity monitoring visits that go with them.
Targeted biologics monoclonal antibodies and targeted agents with the dosing and unit accuracy payers require on high-cost drugs.
Supportive care infusions hydration, anti-emetics, growth factors, and bone-modifying agents billed alongside the primary regimen without triggering bundling denials.
Radiation oncology simulation, treatment planning, dosimetry, IMRT, stereotactic radiosurgery and body radiotherapy, treatment delivery, and weekly treatment management.
Surgical oncology tumor resection, lymphadenectomy, pathology add-ons, and post-operative care, with every billable service captured.
Diagnostic imaging PET, CT, MRI, nuclear medicine studies, and radiopharmaceuticals, with the correct professional and technical components.
Clinical trial billing routine-cost versus investigational-service separation, coded and flagged the way Medicare and payers require to stay compliant.
Evaluation and management visits new and established patient visits, treatment planning, and same-day E/M with an infusion handled through correct modifier 25 support.
Non-covered and investigational services ABN workflow and patient responsibility handling so your practice isn't absorbing the cost of services the payer was never going to cover.
Which Oncology CPT, HCPCS, and ICD-10 Codes
Do You Work With?
| Code Range | What It Covers |
|---|---|
| 99202–99215 | New and established patient E/M visits |
| 96360–96361 | Hydration infusion |
| 96365–96371 | Therapeutic, prophylactic, and diagnostic infusions and injections |
| 96401–96417 | Chemotherapy administration IV push and infusion, initial and each additional hour |
| 96420–96425, 96521–96523 | Intra-arterial chemo and infusion pump refill and maintenance |
| 77261–77299 | Radiation treatment planning and simulation |
| 77300–77370 | Dosimetry and treatment devices |
| 77385–77387, 77401–77417 | IMRT and radiation treatment delivery with guidance |
| 77371–77373, 77427–77435 | Stereotactic radiosurgery, SBRT, and radiation treatment management |
| 88300–88399 | Surgical pathology |
| 78811–78816, 70000-series | PET, CT, MRI, and nuclear medicine imaging |
| J-codes / HCPCS | Chemotherapy, immunotherapy, biologic, and supportive drug supply |
| Z51.11, Z51.12, Z51.0 | Encounter for chemotherapy, immunotherapy, and radiotherapy |
| C50, C34, C61 | Malignant neoplasm of breast, lung/bronchus, prostate |
| C18, C25, C56 | Malignant neoplasm of colon, pancreas, ovary |
| C71 | Malignant neoplasm of brain |
| C81–C86 | Lymphoma |
| C90–C95 | Multiple myeloma and leukemia |
| Z85 | Personal history of malignant neoplasm |
Code sets update annually and payer rules especially drug coverage update more often than that. Keeping current on both is part of the service, not an extra.
Which Modifiers and Indicators Actually Decide
Whether an Oncology Claim Gets Paid?
Discarded drug (wastage) and the no-wastage indicator. On high-cost oncology drugs, this is where documented money is won or lost.
340B drug pricing indicators, applied correctly so covered-entity claims are billed the way the payer requires.
Investigational versus routine clinical services in an approved clinical trial, so trial billing stays compliant.
Significant, separately identifiable E/M on the same day as an infusion or procedure, documented properly.
Distinct procedural service, used when separately billable services are legitimately performed together.
Repeat procedure by the same or a different physician.
Professional versus technical component on imaging and radiation services.
Advance beneficiary notice and non-covered service indicators.
Confirmation that coverage requirements in the payer's policy have been met.
How Does Compliance Work in Oncology Billing?
Drug wastage documentation
Discarded single-use vial drug is billable only when the wastage is documented and coded correctly, and payers increasingly expect an indicator either way. We make sure the documentation supports every wastage line before it goes out.
340B and buy-and-bill integrity
For covered entities and buy-and-bill practices, we keep pricing indicators, inventory separation, and billing straight so claims are both paid and defensible.
Clinical trial billing
We separate routine costs from investigational services and apply the required modifiers and coding so trial claims meet Medicare and payer rules rather than creating audit exposure.
Medical necessity, staging, and coverage policy
Medicare LCDs and drug and imaging policies define what has to be documented diagnosis, staging, and the treatment-encounter code before a claim is covered. We review documentation against the applicable policy before the claim goes out, not after it denies.
HIPAA and data security
Every EverCure Billing team member works under signed HIPAA agreements with role-based access to PHI, secure data transfer, and no PHI on personal devices or unsecured channels.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent claims, denials, drug billing, and your aged A/R to identify where revenue is being lost and how much of it is recoverable.
Findings and scope
You get a written summary of what we found and a clear proposal services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical team.
Workflow mapping
We document your regimen and drug mix, top payers, 340B or buy-and-bill setup, current denial patterns, and internal handoffs, then build the billing workflow around how your practice actually runs.
Go live
Claims start flowing through our process. In parallel, we begin working your existing aged A/R old money is usually the fastest win.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call to go through what's working and what needs to change.
Typical onboarding runs about two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly in your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, Practice Fusion, CareCloud, Epic, and Cerner, along with oncology-specific and infusion-center platforms.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide, with a growing footprint in Indiana and New Jersey.
What Does Oncology Billing Cost?
Our oncology billing services are priced as a percentage of monthly collections so our revenue only grows when yours does. Your exact rate depends on regimen and drug mix, monthly claim volume, payer mix, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. If you want a specific number, the free audit is the fastest way to get one that's accurate rather than generic.
Why Choose EverCure Billing for Oncology Billing?
We work the complex claims, not just the easy ones.
High-cost drug denials, wastage documentation, and infusion time coding take real review, payer policy reading, and appeal writing. That's the work we don't write it off and move on.
You get a named account manager, not a ticket queue.
One person who knows your practice, your payers, and your drug and regimen mix, reachable directly.
Direct access to leadership.
We're built to stay close to our clients. When something goes wrong, you're not escalating through four layers to get an answer.
Denial data goes back into coding.
Every denial reason is tracked and fed back upstream so the same error stops repeating. Most billing companies just resubmit.
Transparent reporting.
You see clean claim rate, denial rate by reason, days in A/R, drug-specific collections, and total collections every month, explained clearly.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Oncology Practice Leaving Money on the Table?
Most oncology practices don't know their real denial rate, how much drug revenue they're losing to wastage and unit errors, or how much they're being underpaid against contracted rates until someone actually looks.
That's what the free audit is for. We review your recent claims, denials, drug billing, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Oncology Billing
Yes. Our team works with the detail oncology billing requires infusion time hierarchy, drug units and NDCs, wastage documentation, 340B and buy-and-bill handling, and cancer staging. General billing knowledge alone doesn't cover any of that.
Infusions follow a strict initial/sequential/concurrent/additional-hour hierarchy with only one initial code per encounter, and the drug itself is billed separately by unit and NDC with wastage documented. Miss any of that and you underbill your most valuable service.
Yes. We log into your current system and work inside it. There is no software to buy and no migration required.
Both. Aged A/R is usually where the fastest recovery is available, so we start working it in parallel with new claim submission.
Yes. We document and code wastage correctly and keep 340B and buy-and-bill claims billed the way the payer requires so they're both paid and defensible.
Yes. We prepare and submit the request, build the clinical summary, follow up until a decision is issued, and track approval expiry dates.
Yes. New provider enrollment, re-credentialing, CAQH maintenance, and Medicare enrollment are all available, either bundled with billing or as a standalone service.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
A monthly report covering collections, clean claim rate, denial rate by reason, days in A/R, drug-specific collections, and payer-level performance plus a review call to walk through it.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Oncology Revenue Cycle?
Every unworked denial, every undocumented wastage line, and every aged claim is money your practice already earned. Let's go get it.
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• Pricing percentage decide whether to state your % range publicly or keep it quote-only. Right now it's quote-only. (Note: for drug-heavy oncology, decide internally how you handle percentage on high drug pass-through so the rate stays fair to both sides.)
• Certifications if/when you have AAPC-certified coders or HIPAA/ISO documentation, add a short certifications block. Don't claim it before it's true.
• Testimonials / case study leave this section out until you have a real oncology client who agrees to be quoted. An empty or fake one costs more trust than it gains.