Oncology and hematology billing for practices and groups: chemotherapy and immunotherapy infusions, the drugs billed by the unit, injections and transfusions, office visits and bone marrow procedures, worked inside the software you already use.
Oncology billing services turn every visit, infusion and drug into a paid claim. Each administration is coded from the start and stop times documented, each drug is billed by the dose given with the right units and modifiers, authorizations are in place before treatment, and every payment, denial and patient balance is followed until it is resolved.
$114M
in improper Medicare payments to hematology and oncology in CMS’s 2025 review, at a 1.7% improper payment rate
66.8%
of those hematology and oncology errors were missing or insufficient documentation, and another 31.2% were incorrect coding
An oncology claim carries some of the most expensive lines in medicine. Drugs are paid by the unit, so a wrong unit count, a missing NDC or an unreported waste amount can cost more than everything else on the claim. The administration codes depend on the order, the method and the minutes of each infusion, and plans want authorization for the regimen before the first dose. A low error rate still means large dollars when each line can be worth thousands.
The infusion record decides the claim. That is why we check the drugs, doses, units and start and stop times on every treatment day before the claim goes out, not after it is underpaid or returned.
Most oncology practices bill infusions, drugs and office visits every day, often for the same patient on the same day.
Pays forChemotherapy, immunotherapy, hydration and supportive infusions and injections, coded by method, order and time.
Where it breaks
What we do
Pays forChemotherapy, immunotherapy, biosimilars and supportive drugs, billed by HCPCS unit with the administration.
Where it breaks
What we do
Pays forOffice visits, bone marrow biopsies, transfusions and port care on treatment and follow-up days.
Where it breaks
What we do
Each infusion day is billed with one initial administration code, and every other service is coded by how it relates to that one. Chemotherapy by infusion is 96413 for up to the first hour, with 96415 for each additional hour, counted once more than 30 minutes of the next hour have passed. A second chemotherapy drug infused after the first is a sequential infusion (96417); other drugs are coded as sequential (96367) or, when infused at the same time, concurrent (96368). Chemotherapy pushes are coded separately: 96409 for the first and 96411 for each additional drug.
The minutes come from the start and stop times in the infusion record, so a note that only lists the drugs cannot support the hours billed. Hydration is billed only when it is medically necessary and runs 31 minutes or more on its own, not while chemotherapy is infusing. In the office, the initial code is the primary reason for the visit; hospital outpatient departments follow the CPT order of chemotherapy, then other therapeutic infusions, then hydration.
What we do: before a treatment day is billed, we read the infusion record for each drug, dose, route and start and stop time, code the initial, sequential and additional hours from it, and match the drug units and waste to the doses given. If a time or dose is missing, we ask the clinic the same day.
Oncology claims pair time-based administration codes with drugs billed by the unit. The table lists them, with what payers check for each drug and service. Commercial plans add their own authorization and bundling rules, and we check each one.
| 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. |
| 9641396415 | Chemotherapy infusion, first hour and each additional hour | Start and stop times documented; an additional hour once more than 30 minutes past the hour. |
| 96417 | Each additional sequential chemotherapy infusion, up to one hour | A different drug given after the first, timed separately. |
| 9640996411 | Chemotherapy by IV push, first drug and each additional drug | Coded by drug, with the administration documented. |
| 9640196402 | Chemotherapy injection under the skin or into muscle, non-hormonal and hormonal | 96402 for hormonal therapy such as leuprolide; the drug billed separately by units. |
| 963659636796375 | Other drug infusions and pushes: initial, sequential and push | Supportive drugs such as antiemetics, coded by order and method. |
| 9636096361 | Hydration | Only when medically necessary and 31 minutes or more, not during chemotherapy. |
| 96523 | Port flush | Billed only when it is the only service that day. |
| 38222 | Bone marrow biopsy and aspiration | One combined code when both are done at the same session. |
| 36430 | Blood transfusion | Billed once per session, with the blood product billed by its supplier. |
| J-codesQ-codes | Chemotherapy, immunotherapy and biosimilar drugs | Units from the dose given, the NDC where required, JZ or JW, and authorization for the regimen. |
An office visit on a treatment day that is significant and separate from the administration. Modifier 25 explained
Required by Medicare on single-dose drugs when the whole dose was given.
The unused amount of a single-dose vial, billed on its own line.
A second initial administration when the protocol required a separate IV site.
Medicare: an erythropoiesis stimulating agent given for anemia caused by chemotherapy, with the lab value the payer requires.
Medicare: a drug or service that may not be covered for the diagnosis, with a signed Advance Beneficiary Notice.
Sources: Medicare Claims Processing Manual, chapter 12 (physician services) and chapter 17 (drugs and biologicals); Medicare National Coverage Determination 110.21 (erythropoiesis stimulating agents in cancer); CMS JW and JZ Modifier FAQs; Medicare NCCI Policy Manual, chapter XI (medicine). 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, infusion coding and times, drug units and waste modifiers, authorizations, 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 open authorizations and active treatment plans, and agree how escalations work. Most practices are live within one to two weeks.
Visits, infusions and drugs are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, infusion times, drug units and waste 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
Oncology claims carry some of the highest drug charges a practice bills, alongside visits and administration. You can pay a billing company a percentage, a flat fee or a price per claim; a percentage keeps its attention on getting those high-value claims paid in full.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What moves the number for an oncology practice is the mix of visits and infusions, how many drugs you buy and bill, authorization volume, and how clean the receivables are when we take them on, which is why we quote your exact rate after the free account review, not before.
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, infusion coding and times, drug units, waste modifiers and authorizations, 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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