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Serving Specialties
Oncology practices face critical billing challenges threatening practice survival. Buy-and-bill procurement demands massive upfront drug investments with 30-90 day reimbursement delays, creating cash flow gaps. Prior authorization bottlenecks delay time-sensitive treatments, while complex HCPC J-code assignments cause costly denials. ASP sequestration slashed Medicare reimbursements 28.4%, dropping payments from ASP+6% to ASP+4.3%. With new 2025 CPT codes and CAR-T therapies costing $373,000-$465,000 per treatment, revenue losses average 12-18%.
Busy oncology providers cannot manage these complexities while providing care. Professional oncology billing services solve these challenges through specialized expertise. Expert teams streamline acquisition, accelerate biologic prior authorizations, and ensure accurate CPT chemotherapy coding (96401-96549). Advanced systems handle drug code validation and crosswalking while maintaining CMS and NCCI compliance. Clinical documentation specialists recover high-value denials through targeted appeals, protecting revenue streams while allowing focus on patient care.
Medcare MSO delivers medical billing for oncology revenue cycles through expert knowledge that general billing companies cannot provide. Our oncology medical billing specialists manage cancer care billing, from buy-and-bill inventory optimization to drug code validation and pharmaceutical crosswalking. The team handles multi-cycle chemotherapy administration coding (96401-96549) and technical/professional component splits for radiation therapy. Our expertise includes 2025 CPT updates and Medicare LCD requirements, with strategic drug pricing calculations maximizing reimbursement while protecting practice margins.
Our AI-integrated technology platform enhances human expertise to deliver superior results. Automated prior authorization workflows expedite approvals for expensive biologics, while real-time eligibility verification prevents costly claim rejections. Clinical documentation specialists leverage deep oncology knowledge to structure effective appeals and peer-to-peer reviews. Advanced denial analytics identify recovery opportunities others miss, while comprehensive compliance monitoring protects against audit risks.
We handle all aspects of oncology medical billing so you can focus on treating patients. Our expert team manages everything from insurance approvals to payment collection, ensuring your practice gets paid faster and more efficiently.
Expedited approvals for expensive biologics and CAR-T therapies.
Expert recovery of high-value denied claims with clinical documentation.
Real-time submission with advanced scrubbing for clean claim rates.
Aggressive collection strategies for aging oncology accounts receivable.
Real-time insurance verification preventing costly claim rejections upfront.
Certified oncology coders ensuring accurate J-code and CPT assignments.
Precise payment processing with detailed revenue tracking and reporting.
Sensitive financial communication for cancer patients and families.
Ongoing regulatory monitoring with comprehensive audit protection services.
Real-time dashboards tracking profitability, collections, and denial trends.
Comprehensive coverage analysis for complex oncology treatment protocols.
Cancer patient information demands the highest protection levels due to sensitive diagnosis data and high-value treatment protocols worth hundreds of thousands of dollars. Medcare MSO’s security infrastructure is specifically designed for oncology’s unique data management challenges, from genetic testing results to expensive CAR-T therapy documentation requiring maximum confidentiality.
Our platform operates within SOC 2 Type II-certified environments with 256-bit AES encryption, biometric access controls, and continuous threat monitoring. Specialized compliance teams track CMS oncology regulations and Medicare LCD updates, implementing changes immediately. All personnel complete rigorous HIPAA training while automated audit systems create immutable records of all activities, protecting against regulatory violations and financial exposure.
Medcare MSO delivers specialized oncology billing services designed exclusively for the complex financial demands of cancer care. Our revenue cycle management is designed to handle the specific demands of advanced treatment procedures, specialty medication management, and comprehensive care coordination.
Strategic drug procurement with ASP monitoring through expert oncology billing services to cut
Advanced mapping of chemotherapy agents and biologics with precise NDC crosswalks for accurate billing.
Seamless billing across extended chemotherapy and immunotherapy sequences with proper timing coordination.
Dedicated teams handle CAR-T therapies and expensive biologics with extensive documentation.
Expert handling of treatment planning and delivery with proper component separation and modifier usage.
Specialized review of treatment protocols and staging to strengthen medical necessity requirement standards.
Integrated billing across medical, radiation, and surgical oncology with proper revenue attribution methods.
Sensitive communication about treatment costs and financial assistance programs for cancer care patients.
Ongoing monitoring of CMS updates and payer policy changes with proactive compliance management.
Real-time tracking of treatment profitability and drug margins with tailored oncology reporting solutions.
Expert recovery of high-dollar denials using clinical evidence and oncology-specific medical criteria standards.
Proactive follow-up on aging oncology claims with specialized collection strategies and considerations.
Our certified specialists master both complex procedure coding and specialty-specific requirements for complete medical billing for oncology revenue cycle management.
| Category | CDT Range | Description | ICD‑10 | ICD‑10 Description |
|---|---|---|---|---|
| Chemotherapy Administration | 96401–96549 | IV push, infusion, intra-arterial chemo | C00-C96, Z51.11 | Malignant neoplasms, chemo encounter |
| Radiation Therapy | 77261–77799 | Planning, delivery, IMRT, brachytherapy | C00-C96, Z51.0 | Malignant neoplasms, radiotherapy encounter |
| Surgical Oncology | 19000–60699 | Tumor resections, biopsies, staging procedures | C00-C96, Z85 | Malignant neoplasms, history of cancer |
| Therapeutic Drug Administration | 96365–96379 | Non-chemo infusions, biologics, supportive care | Z51.12, T45.1X5A | Immunotherapy encounter, drug effects |
| CAR-T & Cell Therapy | 38225–38228 | Cell processing, conditioning, administration | C91-C95, Z94.84 | Hematologic cancers, stem cell transplant |
| Photodynamic therapy Procedures | 96567–96574 | Stem cell rescue, conditioning regimens | C81-C96, Z94.84 | Hematologic cancers, stem cell status |
| Pathology & Laboratory | 88300–88399 | Tissue analysis, cytology, flow cytometry | C00-C96, R89-R94 | Malignant neoplasms, abnormal findings |
| Interventional Oncology | 75894–75898 | Diagnostic Radiology (Procedures for vascular) | C00-C96, Z51.89 | Malignant neoplasms, other treatment |
| Genetic Testing | 81162–81479 | Hereditary cancer panels, mutations | Z15.01-Z15.09 | Genetic susceptibility to cancer |
| Evaluation & Management | 99202–99499 | Office visits, consultations, hospital care | C00-C96, Z08 | Malignant neoplasms, follow-up exam |
| Pain Management | 62320–64999 | Nerve blocks, pumps, trigger point injections | G89.3, R52 | Cancer-related pain, chronic pain |
| Palliative & Supportive Care | 96360–99498 | Hydration, anti-emetics, end-of-life discussions | Z51.5, Z51.81 | Palliative care, therapeutic monitoring |
CDT Range: D0100–D0999
Description: Exams, x-rays, diagnostics
ICD-10 Codes: Z01.20, K00–K14
ICD-10 Description: Dental exams, Tooth development disorders
CDT Range: D1000–D1999
Description: Cleanings, fluoride, sealants
ICD-10 Codes: Z00.00, K05.0
ICD-10 Description: Routine exam · Gingivitis
CDT Range: D2000–D2999
Description: Fillings, crowns, veneers
ICD-10 Codes: K02.3, K08.1
ICD-10 Description: Caries · Tooth loss
CDT Range: D3000–D3999
Description: Root canals, pulpotomy
ICD-10 Codes: K04.0–K04.9
ICD-10 Description: Pulpitis · Periapical abscess
CDT Range: D4000–D4999
Description: SRP, perio surgery, maintenance
ICD-10 Codes: K05.3, K05.6
ICD-10 Description: Chronic periodontitis · Other perio disease
CDT Range: D5000–D5899
Description: Dentures, relines
ICD-10 Codes: K08.1–K08.5
ICD-10 Description: Edentulism · Tooth loss (trauma/causes)
CDT Range: D5900–D5999
Description: Facial/jaw prostheses
ICD-10 Codes: Q67.4, K02.0
ICD-10 Description: Jaw deformities · Facial anomalies
CDT Range: D6000–D6199
Description: Implant placement & upkeep
ICD-10 Codes: Z96.5, K08.1
ICD-10 Description: Implants present · Partial edentulism
CDT Range: D6200–D6999
Description: Bridges, fixed crowns
ICD-10 Codes: K08.40, K08.402
ICD-10 Description: Partial edentulism (upper/lower)
CDT Range: D7000–D7999
Description: Extractions, grafts, TMJ
ICD-10 Codes: S02.x, K10.x
ICD-10 Description: Jaw fractures · Cysts/tumors
CDT Range: D8000–D8999
Description: Braces, aligners, retainers
ICD-10 Codes: K07.1–K07.4, M26.3
ICD-10 Description: Malocclusion · Jaw anomalies
CDT Range: D9000–D9999
Description: Anesthesia, consults, ER
ICD-10 Codes: Z51.81, R68.2, T81.4
ICD-10 Description: Pre/Post-op care · Complications
Maximus medical billing software unifies oncology revenue cycle management into one intelligent, cloud-based platform. It validates J-codes and CPT chemotherapy administration codes in real-time, identifies buy-and-bill risks, and submits clean claims to major payers instantly. Maximus’s built-in patient eligibility verification workflows prevent treatment delays while advanced algorithms achieve 90%+ first-pass acceptance rates. Additionally, real-time dashboards track drug administration revenue and aged A/R balances. Maximus operates on HIPAA-certified infrastructure and generates automated compliance reports for seamless audit readiness, delivering comprehensive oncology medical billing solutions.
Chief Operating Officer, MAKO MEDICAL LABORATORIES
Chief Executive Officer, CARE NOW CLINIC
Chief Operations Officer, ION DIAGNOSTICS
Co-Founder, AW Care
Oncology credentialing demands specialized expertise that general oncology billing services cannot provide effectively. Major insurance networks require comprehensive verification of oncology subspecialty board certifications, fellowship training documentation, and multi-state medical licensing. Payers also mandate detailed malpractice insurance validation, hospital privilege verification, and continuing medical education compliance specific to cancer care standards.
As a specialized oncology billing company, Medcare MSO credentialing experts navigate complex payer networks including Medicare Advantage plans, major commercial insurers, and Cancer Centers of Excellence programs. Our primary source verification process handles board certifications, residency documentation, DEA registrations, and specialty-specific requirements. Real-time tracking monitors committee reviews, contract negotiations, and enrollment timelines while ensuring documentation meets each payer’s criteria.
Oncology practices maximize revenue through strategic revenue optimization that targets cancer care’s highest-value opportunities. Expert oncology billing services help accelerate cash flow by streamlining prior authorization workflows for biologics, reducing approval times from weeks to days. Afterwards, advanced claim scrubbing technology catches coding errors before submission. This achieves higher first-pass acceptance rates and eliminate costly rework cycles.
Additionally, analytics identify revenue leakage patterns across payer contracts, drug administration cycles, and denial trends, providing proactive corrections. Real-time eligibility verification prevents claim rejections and automated follow-up systems recover aged receivables faster than manual processes. Lastly, specialized appeal strategies leverage oncology-specific medical necessity documentation to overturn high-value denials.
Oncology providers focus intensively on delivering life-saving treatments, often leaving revenue cycle management as a secondary priority. This patient-first approach frequently results in overlooked billing opportunities and administrative oversights that impact practice profitability. Common issues include incomplete charge capture during treatment sessions, missed supportive care billing, and inadequate follow-up on pending authorizations.
Additionally, staff turnover creates inconsistencies in coding accuracy and claim submission processes. Our complimentary Oncology Revenue Cycle Assessment systematically reviews your current operations, identifying areas where revenue is lost and processes that need improvement. This evaluation provides concrete recommendations to optimize workflow, enhance efficiency, and ensure appropriate reimbursement.
MedCare MSO provides white-label oncology billing services that integrate seamlessly into your current operations. Our certified billing specialists manage complete revenue cycle operations, claims processing, denial management, and accounts receivable follow-up for your clients across all medical specialties.
Additionally, we handle prior authorization workflows, coding accuracy, patient billing, and compliance monitoring using industry-standard documentation practices. By partnering with our proven medical billing solutions, you gain access to comprehensive expertise that supports billing companies nationwide without the overhead of hiring and training specialized staff.
Complex oncology regulations and stringent prior authorization requirements challenge most general medical billing companies. We eliminate that risk by deploying specialists trained exclusively in cancer care billing complexities, protecting your practice from costly denials, audit penalties, and compliance violations. We serve oncology providers across all 50 states:
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We specialize in oncology’s unique challenges: buy-and-bill drug procurement, J-code mapping for expensive biologics, and prior authorization workflows for high-value treatments. Our team handles multi-cycle chemotherapy coding, ASP calculations, and clinical appeals that general billing companies cannot manage effectively.
Professional oncology billing services eliminate the revenue losses most practices experience from denied CAR-T claims, delayed biologic approvals, and incorrect J-code assignments. Our specialists recover high-dollar denials and speed up prior authorization that in-house teams typically struggle with, while freeing your clinical staff to focus on patient care.
We use a straightforward percentage-of-collections model with no hidden fees. Unlike other companies that charge separately for prior authorizations or appeals, our single fee covers everything from buy-and-bill management to clinical documentation and compliance monitoring.
Our oncology billing company provides complete buy-and-bill management, automated prior authorization workflows, J-code validation, clinical appeals, patient financial counseling, and compliance monitoring. Our package includes real-time ASP tracking, seamless EHR integration, and comprehensive reporting – everything needed for optimal oncology revenue cycle management.
Our oncology billing services team of AAPC-certified specialists focuses exclusively on cancer care billing. They’re trained in chemotherapy administration sequences, radiation therapy components, CAR-T documentation, and clinical appeals processes. We provide quarterly updates on CMS oncology changes to ensure coding accuracy.
Yes, we’re enrolled with all major commercial networks, Medicare Advantage plans, state Medicaid oncology programs, and Cancer Centers of Excellence networks. Our payer specialists maintain current coverage policies and prior authorization requirements for your specific insurer mix.
We operate on HITRUST-certified, HIPAA-compliant infrastructure with specialized security for cancer patient data. Our team receives oncology-specific privacy training, and we provide automated audit preparation and compliance monitoring to protect your practice from regulatory risks.
We charge only a percentage of the revenue we collect, there are no upfront costs, software fees, or hidden charges. This straightforward fee structure ensures you pay only for results, with no surprises.
Get faster payments, fewer denials, and higher collections with our expert dental billing team handling your revenue cycle.
