MedCare Billing Solutions provides expert oncology medical billing for medical oncologists, hematology-oncology practices, radiation oncology centers, and cancer infusion clinics. We specialize in chemotherapy administration coding, drug HCPCS billing (buy-and-bill), oral oncology parity, and radiation therapy RCM — the highest-stakes billing in all of medicine.
A single chemotherapy infusion claim can exceed $50,000 — and payers audit oncology claims aggressively. The cost of a billing error in oncology isn't $50; it's $5,000–$50,000. Common devastating mistakes include:
Oncology practices that use the buy-and-bill model are reimbursed at ASP + 6% (Medicare) for administered drugs. A single incorrect J-code on a $30,000 immunotherapy drug claim = a $30,000 denial. MedCare's oncology specialists verify every drug code against the NDC and dose administered before submission.
Our coders are trained on chemotherapy administration, drug HCPCS, radiation oncology treatment codes, and oral oncology billing.
| Code | Procedure / Drug | Common Billing Issue |
|---|---|---|
| 96413 | Chemotherapy infusion, initial (up to 1 hr) | Subsequent hours (96415) not added; push vs. infusion code confusion |
| 96367–96368 | Sequential / concurrent infusion add-ons | Routinely missed — $150–$400 per encounter uncollected |
| 96401–96402 | Chemotherapy push injection (non-hormonal / hormonal) | IV push billed as infusion; incorrect code for subcutaneous route |
| J9299 / J9999 | Unclassified antineoplastic drug | Used as fallback when specific J-code exists — triggers manual review |
| J0129 / J0897 | Abatacept / Denosumab (high-cost biologics) | NDC number missing from claim — automatic denial on Medicare |
| 77385–77386 | IMRT delivery (simple / complex) | Simple vs. complex IMRT distinction errors; planning codes not billed |
| 77261–77263 | Radiation treatment planning (simple/intermediate/complex) | Under-utilized — billing simple when complex planning was performed |
| 99214–99215 + -25 | Oncology E/M visits on infusion days | E/M not billed same day as chemotherapy — missed when modifier -25 applies |
Precise J-code selection with NDC cross-reference for every drug administered. We verify drug codes against dose, concentration, and route before every claim submission.
Complete infusion coding — initial, subsequent hours, sequential, and concurrent add-ons fully captured. No infusion minute goes unbilled on our watch.
Expert billing for IMRT, 3D-CRT, SBRT, brachytherapy, and simulation planning. We correctly classify treatment complexity to maximize reimbursement.
Full prior auth management for every chemotherapy and immunotherapy cycle. We track auth expiry, reauthorization timelines, and dose-change updates.
Oral chemotherapy billing and parity law enforcement across states that require coverage parity between IV and oral oncolytics — a growing revenue stream.
Specialized oncology denial appeals team. When a $40,000 immunotherapy claim is denied, we fight it with clinical documentation, peer-to-peer reviews, and formal appeals.
Get a free oncology billing audit. We'll analyze your drug J-code accuracy, infusion add-on capture, and prior authorization management — and show you what's at risk.