Hematology billing for practices and groups that treat non-cancer blood disorders: anemia and IV iron, erythropoiesis-stimulating agents, hemophilia and other bleeding disorders, sickle cell disease, therapeutic phlebotomy and bone marrow procedures, worked inside the software you already use.
Hematology billing turns every visit, infusion and procedure into a paid claim. Each drug is billed in its own unit size, lab values that coverage depends on are on the claim, procedures are coded to what was done, and underpaid drug lines are taken up with the payer.
100,000
people in the US are estimated to live with sickle cell disease, according to the CDC
33,000
males in the US are estimated to live with hemophilia, according to CDC research
Hematology bills drugs whose unit sizes have nothing in common. One iron product is billed per milligram and another per 12.5 or 50 milligrams, clotting factor is billed per international unit, and erythropoiesis-stimulating agents need lab values and modifiers that explain why the patient is anemic. A wrong conversion can overbill or underbill a single infusion by a wide margin.
The unit size and the lab values decide the claim. That is why we check every dose against its code’s unit and every ESA against the labs and modifiers coverage requires, before the claim goes out.
Non-cancer hematology bills infusions, factor products and procedures, often for long-term patients. Each fails in its own way. Here is where claims in each area fail, and what we do.
Pays forIV iron infusions and erythropoiesis-stimulating agents for anemia, billed with the drug, the units and the administration.
Where it breaks
What we do
Pays forClotting factor products and other treatments for hemophilia and von Willebrand disease, given in the clinic or dispensed for home use.
Where it breaks
What we do
Pays forBone marrow biopsies, therapeutic phlebotomy, transfusions, and visits and infusions for sickle cell disease.
Where it breaks
What we do
IV iron products are billed in different units. Ferric carboxymaltose (J1439) and iron sucrose (J1756) are billed per 1 mg, sodium ferric gluconate (J2916) per 12.5 mg and iron dextran (J1750) per 50 mg. A 750 mg dose of ferric carboxymaltose is 750 units; the same arithmetic applied to iron dextran would be wrong by a factor of 50. Single-dose vials also need JZ or a JW line for waste.
Erythropoiesis-stimulating agents, such as epoetin alfa and darbepoetin, carry extra rules. Medicare covers them for anemia from cancer chemotherapy only when hemoglobin is below 10 g/dL, and every claim needs a modifier saying why the patient is anemic: EA for chemotherapy, EB for radiotherapy and EC for other causes, with the lab value the payer requires.
What we do: before an iron or ESA claim goes out, we convert the dose with that product’s unit size, check the waste modifier, and for ESAs confirm the hemoglobin, the cause of anemia and the modifier that matches it.
Hematology claims mix drugs in very different unit sizes with a few key procedures. These are the codes behind most of them, with what payers check on each.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 25 with a same-day procedure only when the visit is separate. |
| J1439J1756 | Ferric carboxymaltose and iron sucrose, per 1 mg | Units equal to the milligrams given, and JZ or JW. |
| J2916J1750 | Sodium ferric gluconate (per 12.5 mg) and iron dextran (per 50 mg) | The dose divided by the code's unit size. |
| J0885Q5106J0881 | Epoetin alfa and its biosimilar (per 1,000 units) and darbepoetin (per 1 mcg), non-ESRD | EA, EB or EC, the lab value, and the coverage rule. |
| J7190 to J7213 | Clotting factor products, per international unit | The actual units dispensed, and authorization for the product. |
| 38222 | Bone marrow biopsy and aspiration | One combined code when both are done in the same session. |
| 99195 | Therapeutic phlebotomy | The indication documented; not a routine blood draw. |
| 36430 | Blood transfusion | Once per session, with the blood product billed by its supplier. |
| 9636596374 | Infusion and IV push administration | From the documented start and stop times. |
Medicare: an ESA given for anemia caused by cancer chemotherapy.
Medicare: an ESA given for anemia caused by radiation therapy.
Medicare: an ESA given for anemia not caused by chemotherapy or radiotherapy.
Required by Medicare on single-dose drugs when the whole dose was given.
The unused part of a single-dose vial, billed on its own line.
A visit significant and separate from a same-day procedure or infusion. Modifier 25 explained
Sources: Medicare National Coverage Determination 110.21; Medicare Claims Processing Manual, chapter 17 (drugs and biologicals); CMS JW and JZ Modifier FAQs. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, drug units by product, ESA labs and modifiers, factor billing, procedures, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list active infusion patients and factor authorizations, and agree how escalations work. Most practices are live within one to two weeks.
Visits, infusions and procedures are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, unit sizes, lab values and modifiers checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
In hematology, a single infusion can carry a large drug charge, and unit errors run in both directions. A fee tied to collections keeps us focused on billing each dose correctly, so payments come in right the first time.
Summit Billing Solutions charges between 3% and 9% of monthly collections. Your rate depends on infusion volume, how much drug you buy and bill, factor and authorization volume, and the state of the receivables, which the free account review shows.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, drug units by product, ESA labs and modifiers, factor billing and procedures, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
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