Specialties › Oncology Billing
Oncology is the highest-revenue, highest-complexity, highest-risk billing environment in all of medicine. A single chemotherapy infusion day generates 8–12 separate billable codes. One immunotherapy infusion day can carry $18,000–$40,000 in drug J-code value alone. Missed infusion add-on hours, unbilled pre-medications, incorrect sequential vs. concurrent coding, and prior authorization failures on high-cost biologics — each one a systematic revenue drain that compounds across every treatment cycle your practice delivers.
The average oncology practice loses $340,000–$1.4M annually to missed drug J-codes, incorrect infusion sequencing, unbilled hydration and pre-medication codes, and prior authorization failures on high-value chemotherapy and immunotherapy claims. A ParaMed oncology billing audit identifies every gap in 30 days — at zero cost to your practice.
Oxaliplatin + Leucovorin + 5-FU bolus + 5-FU continuous pump · Pre-meds · Hydration
Primary chemo agent · Drug J-code
First hour administration code
Each additional hour — 5 hr total infusion
Second drug sequential administration
Anti-emetic pre-medication + IV push admin
Pre/post-chemo hydration codes
Physician evaluation and management
Most practices bill: $4,532 (only J9263 + 96413). Missing: add-on hours, sequential drug codes, pre-meds, hydration. Revenue gap: $1,542 per FOLFOX day. For 20 patients × 12 cycles = $370,080/year from one regimen.
J9271 (pembrolizumab 200mg) = $18,000 in drug value before infusion admin, pre-meds, or E&M. Missing this J-code on one infusion day loses more than many practices collect in an entire week.
Ondansetron, dexamethasone, granisetron, and other pre-medications given before chemotherapy are separately billable J-codes. IV hydration before and after chemo generates additional revenue on virtually every infusion day.
Practices treating 30+ immunotherapy patients monthly with checkpoint inhibitors and missing or under-coding J-codes face the largest per-practice revenue gaps in all of outpatient medicine.
Complete drug J-code capture, correct infusion hour sequencing, pre-medication billing, hydration codes, prior authorization management, and E&M complexity optimization combined drive an average 41% revenue increase within 90 days.
Every chemotherapy infusion day generates drug J-codes, infusion hour codes, sequential drug codes, pre-medication J-codes, hydration codes, port access fees, and an E&M visit. General billing teams typically submit 2–3. ParaMed submits all of them.
CAR-T cell therapy (axicabtagene ciloleucel, J0131) carries $373,000 in drug J-code value on a single treatment day. Pembrolizumab: $18,000. Daratumumab: $15,680. Ipilimumab-nivolumab combo: $79,800+. The per-encounter financial stakes in oncology are without parallel in any other specialty.
Every checkpoint inhibitor, every targeted biologic, every CAR-T therapy requires prior authorization before the infusion date. PA failures on $18,000+ infusion claims result in complete denial of the highest-value code on the claim.
Oncology claims require precise ICD-10 coding: primary malignancy site, laterality, histology-specific codes, staging codes, encounter type, and treatment-related complication codes. Incorrect cancer ICD-10 specificity is one of the top denial triggers across all major payers.
Chemotherapy, immunotherapy, targeted therapy, radiation, surgical oncology, and hematology each operate on completely different code sets, prior auth rules, and revenue structures.
Chemotherapy infusion billing follows a strict hierarchy that determines which drug is the "primary" infusion (96413 for first chemo drug, first hour), which additional hours are add-ons (96415 per hour), which subsequent drugs are sequential (96417 per sequential new drug), and which are concurrent. Getting this hierarchy wrong doesn't just lose revenue — it triggers payer denials on the entire claim.
| CPT/HCPCS | Description | Rate |
|---|---|---|
| 96413 | Chemo infusion — initial drug, first hour (primary) | $248 |
| 96415 | Each additional infusion hour — add-onPer Hour | $124 |
| 96417 | Sequential chemo — each new drugMost Missed | $224 |
| 96409 | IV push — chemo, each substance | $184 |
| 96360 | IV hydration — initial 31 min to 1 hrOften Missed | $128 |
| 96361 | IV hydration — each additional hour | $96 |
| J2405 | Ondansetron IV 4mg — anti-emetic pre-med | $48 |
| 96523 | Port flush/access — implanted catheter | $64 |
Drugs + all admin hours + pre-meds + hydration + port
Checkpoint inhibitor immunotherapy (pembrolizumab, nivolumab, atezolizumab, ipilimumab) represents the largest per-encounter drug billing values in oncology. Pembrolizumab (J9271) alone carries $90/mg — a 200mg dose = $18,000 per infusion day in drug J-code value. Without an active prior authorization on file, the entire $18,000 drug J-code is denied.
| HCPCS | Description | Rate |
|---|---|---|
| J9271 | Pembrolizumab (Keytruda) per 1mg — 200mg dose$18K/dose | $90/mg |
| J9299 | Nivolumab (Opdivo) per 1mg — 240mg$8.6K/dose | $36/mg |
| J9228 | Ipilimumab (Yervoy) per 1mg — 3mg/kgHigh Value | $380/mg |
| J9022 | Atezolizumab (Tecentriq) per 10mg | $88/10mg |
| J9060 | Durvalumab (Imfinzi) per 10mg | $78/10mg |
| 96413 | Immunotherapy infusion — initial hour | $248 |
| 96417 | Sequential drug — second checkpoint inhibitor | $224 |
| 99215 | Complex oncology E&M — immunotherapy mgmt | $328 |
J9271×200 + 96413 + E&M + pre-meds
Targeted therapy billing divides into two distinct tracks: IV-administered monoclonal antibodies that follow the same infusion J-code structure as chemotherapy, and oral targeted agents (TKIs) dispensed through specialty pharmacy. IV targeted agents generate drug J-codes and infusion administration codes. Oral TKI management generates high-complexity E&M visits.
| HCPCS | Description | Rate |
|---|---|---|
| J9355 | Trastuzumab per 10mg — HER2+ (420mg = $3,360)HER2+ | $80/10mg |
| J9035 | Bevacizumab per 10mg — CRC/NSCLC/ovarian | $46/10mg |
| J9055 | Cetuximab per 10mg — RAS-wt CRC/HNSCC | $38/10mg |
| J9358 | Trastuzumab deruxtecan (Enhertu) per 0.5mg | $168/0.5mg |
| J9312 | Rituximab per 100mg — NHL/CLL$4.1K/dose | $588/100mg |
| 99215 | Oral TKI management — high complex MDM | $328 |
| 96417 | Sequential targeted drug — after primary chemo | $224 |
| 96413 | Targeted agent infusion — initial hour (if primary) | $248 |
J9355×42 + 96413 + 96415×1 + pre-meds vs. E&M only
Radiation oncology billing operates on a distinct code set — treatment planning codes, simulation, dosimetry, weekly treatment management (77427), and radiation delivery codes. The most consistently missed revenue: 77427 generates $212 for every 5 radiation fractions delivered — for a standard 30-fraction course, that's 77427 × 6 = $1,272 in management revenue per patient that is consistently under-billed.
| CPT | Description | Rate |
|---|---|---|
| 77427 | Weekly radiation mgmt (per 5 fractions)Most Missed | $212 |
| 77386 | IMRT delivery complex — SBRT/SABR | $448/fx |
| 77385 | IMRT delivery — standard | $284/fx |
| 77263 | Therapeutic radiology plan — complex | $448 |
| 77293 | Respiratory motion management simulation | $384 |
| 77014 | CT guidance — radiation field placement | $188/fx |
| 77300 | Basic dosimetry calculation per field | $64 |
| 77280 | Simulation — simple | $224 |
Delivery + weekly mgmt ×6 + planning + simulation
Surgical oncology billing combines the primary tumor resection, nodal staging procedures, margin assessment pathology, and reconstruction into a multi-component operative claim. The most consistently missed codes: sentinel lymph node biopsy injection (38900, $188), intraoperative frozen section (88331, $188) for margin assessment, and immediate reconstruction add-ons (19340 implant, $1,880; 19357 expander, $1,440) following mastectomy.
| CPT | Description | Rate |
|---|---|---|
| 38900 | Sentinel node injection — intraoperativeOften Missed | $188 |
| 38525 | Sentinel node excision — axillary | $1,240 |
| 19303 | Simple complete mastectomy | $2,840 |
| 19340 | Immediate implant reconstructionAdd-On | $1,880 |
| 88331 | Intraoperative frozen section — first blockMargin | $188 |
| 19302 | Partial mastectomy with axillary dissection | $2,240 |
| 19357 | Tissue expander post-mastectomyAdd-On | $1,440 |
| 38745 | Complete axillary lymph node dissection | $1,680 |
19303 + 38900 + 38525 + 19340 vs. mastectomy alone
Hematologic oncology generates the widest range of billing complexity — from bone marrow biopsies ($788/procedure) and flow cytometry panels ($184 + $68/marker) at the diagnostic end, to CAR-T cell therapy at $373,000 per treatment on the therapeutic end. Rituximab, daratumumab, bortezomib, and carfilzomib are all high-value infusion agents with complex dosing schedules.
| CPT/HCPCS | Description | Rate |
|---|---|---|
| J9312 | Rituximab per 100mg — NHL/CLL/DLBCL | $588/100mg |
| J9145 | Daratumumab per 10mg (Darzalex)$15.7K/dose | $140/10mg |
| 38220 | Bone marrow aspirationOften Missed | $584 |
| 38221 | Bone marrow needle biopsy | $788 |
| 88184 | Flow cytometry — first marker analyzed | $184 |
| 88185 | Flow cytometry — each additional marker | $68/marker |
| J0131 | CAR-T axicabtagene ciloleucel$373K | $373,000 |
| 88262 | Chromosomal analysis — 15–20 cells | $448 |
38220 + 38221 + 88184 + 88185 ×11 vs. one code
A single FOLFOX-6 infusion day correctly coded generates 8 distinct billing codes across 3 categories: drug J-codes (70% of revenue), administration codes (infusion hours, hydration, port), and the physician E&M visit. Most practices capture only the drug J-code and the initial infusion code — leaving 30% of encounter revenue unbilled on every single treatment day.
85mg/m² IV over 2 hours — drug acquisition cost billed as J-code
Primary administration code — first drug, first hour of infusion
Each additional hour beyond first — 5-hour total = 4 add-on codes
Second drug J-code + sequential administration — NOT another 96413
5-FU bolus + pump — single J-code for total daily dose administered
Anti-emetic before chemo — drug J-code + administration code each separately billed
Pre/post-chemo saline hydration — initial 31-min + additional hour add-on
Physician evaluation — reviewing labs, toxicity, treatment response, and cycle continuation decision
The drug J-code is the single highest-revenue item on any oncology infusion claim — and the most vulnerable to denial, under-coding, and documentation failures. Prior authorization must be in place before the infusion date. Dose quantity on the claim must exactly match the administration record. ICD-10 diagnosis must match the approved indication on the PA.
High-complexity oncology visit — reviewing imaging response, tumor markers, performance status, toxicity assessment. 99215 supported by MDM complexity of active cancer management.
99215$328J9271 per 1mg — 200mg dose = J9271 × 200. Prior auth number referenced on claim. Dose must exactly match administration record and order. ICD-10 must match approved indication.
J9271 × 200$18,00096413 — initial infusion hour. Pembrolizumab infuses over 30 min — only 96413 applies (no 96415 add-on). PA number, drug lot number, and administration nurse documentation required.
96413$248PD-1 checkpoint inhibitor — 30+ approved cancer types. 200mg Q3W or 400mg Q6W. Prior auth mandatory per infusion date. Biomarker documentation required per indication (PD-L1 TPS, TMB-H, MSI-H).
Dual checkpoint blockade for melanoma and RCC. Two J-codes on same infusion day — each requiring separate prior authorization and sequential administration coding (96413 primary + 96417 sequential).
Anti-CD20 antibody for NHL, DLBCL, follicular lymphoma, CLL. 375mg/m² dose — first infusion over 6–8 hours. Pre-medication with acetaminophen + diphenhydramine required before every infusion — both separately billable.
Anti-CD38 for multiple myeloma. 16mg/kg Q1W × 8, Q2W × 8, then Q4W. Extensive pre-medication protocol. First infusion over 6+ hours requiring maximum add-on hour coding.
Anti-HER2 monoclonal antibody for HER2+ breast, gastric, HER2-low. 6mg/kg loading then 4mg/kg Q3W maintenance. HER2 IHC/FISH documentation required on every PA. Pertuzumab (J9313) often given concurrently — requiring 96417 sequential for the second HER2-targeted agent.
Standard doublet for NSCLC, ovarian, HNSCC, endometrial. Sequential administration — paclitaxel first (mandatory premedication with corticosteroids for hypersensitivity), then carboplatin. Paclitaxel mandatory premedication: dexamethasone + diphenhydramine + ranitidine — 3 separately billable drug codes before the chemo even begins.
Every high-cost oncology drug requires prior authorization before the infusion date. A lapsed, expired, or incorrectly-referenced PA on an $18,000 infusion claim results in complete denial of the drug J-code — the highest-value item on the claim. ParaMed manages prior authorization initiation, tracking, renewal, and claim-PA linkage for every oncology drug your practice administers.
Biomarker results, AJCC staging, ECOG performance status, and treatment plan submitted to payer
PD-L1 TPS, TMB-H, MSI-H, HER2 IHC/FISH, EGFR mutation — each indication requires its own biomarker result in the PA submission
Authorization number received — must be linked to every infusion claim for the approved drug and diagnosis. PA number goes on the claim
Drug administered — J-code quantity verified against admin record, PA number referenced on the claim, infusion date within PA validity period
PA renewal initiated 14 days before expiration — missed renewal = denied infusion claim. Renewal requires updated response assessment documentation
Immediate appeal with clinical documentation, peer-to-peer request, and escalation to medical director review — every denial appealed within 48 hours
The single most expensive prior authorization failure: the patient's PA for pembrolizumab expires between infusion cycles, the renewal wasn't initiated in time, and the infusion proceeds on the scheduled date with an expired authorization. The payer denies the J9271 drug code — $18,000 denied on a single claim. For practices with 20+ pembrolizumab patients on Q3W dosing, managing 60+ active PA authorizations simultaneously, even one missed renewal can be catastrophic.
Pembrolizumab approved for NSCLC PD-L1 ≥50% has a different indication and PA approval pathway than pembrolizumab for NSCLC PD-L1 1–49% (combination with chemotherapy). When the PA is approved under one indication but the claim is submitted with a different ICD-10 code or the biomarker documentation doesn't match — the entire claim is denied as "not medically necessary for the approved indication."
Many payers require Clinically Meaningful Response (CMR) documentation at PA renewal for checkpoint inhibitor continuation — imaging evidence that the patient is responding to treatment on RECIST criteria. When a PA renewal is submitted without updated imaging response documentation, the renewal is denied and the subsequent 3–6 infusion cycles are uninsured.
Oncology visits involve some of the most complex medical decision-making in all of medicine — reviewing imaging response, interpreting tumor markers, evaluating treatment toxicity, making treatment continuation or modification decisions, coordinating multi-specialty care, and managing life-threatening complications. These visits consistently support 99215 (high complexity, $328). Most oncology practices reflexively bill 99213 or 99214 for routine treatment visits — losing $110–$223 per visit.
Established patient on pembrolizumab Q3W for NSCLC PD-L1 ≥50%. Physician independently interprets CT chest response (partial response, RECIST), reviews LFTs for hepatotoxicity, evaluates new onset dry cough for possible pneumonitis, decides to continue treatment, orders HRCT for pneumonitis evaluation, and adjusts anti-emetic regimen. This is unambiguous high-complexity MDM: independent imaging interpretation, new symptom evaluation with dangerous drug toxicity as the differential, prescription drug management decision, and independent data review.
CLL patient on ibrutinib with rising WBC and lymph node enlargement on restaging CT — disease progression on current therapy. Oncologist reviews peripheral blood flow cytometry, bone marrow biopsy result from last week, external CT read and their own image review, discusses case at tumor board, decides to transition to venetoclax + obinutuzumab. This is the clearest possible high-complexity MDM: disease progression requiring new treatment line selection, independent testing interpretation across multiple modalities, tumor board consultation, and initiation of new high-risk medications.
New patient with newly diagnosed Stage IIB HER2+ breast cancer. Oncologist reviews pathology report, IHC results, staging PET-CT, echocardiogram for cardiac baseline (trastuzumab cardiotoxicity monitoring), and discusses treatment options (TCH vs. TCHP neoadjuvant), clinical trial eligibility, and genetic counseling referral. External records reviewed. Multi-specialty treatment plan designed. 99205 (new patient, high complexity) is the correct code — not 99214.
Each denial pattern below is systemic — not isolated. Every one affects the same code categories, the same encounter types, the same documentation failures — across every billing cycle. All are correctable. None require seeing more patients.
The most pervasive revenue gap in oncology infusion billing: 96415 (each additional infusion hour) is never billed. Every infusion hour beyond the first generates a separately billable 96415 at $124. A 5-hour infusion = 96413 + 96415 × 4 = $744 in administration codes. Practices billing only 96413 collect $248 — losing $496 per encounter. At 3 infusion days/month × 20 patients × 12 months = $357,120 annually from one missing code category.
The infusion hierarchy rule requires that the first drug uses 96413. Every subsequent drug given sequentially uses 96417 ($224). A billing team that doesn't know this rule submits 96413 twice — triggering an automatic payer edit that denies the second 96413 as a duplicate. For a 3-drug regimen: 2 missed 96417 codes = $448/infusion day × 3 cycles/month × 20 patients = $32,256/month.
Pre-chemotherapy medications (ondansetron J2405, granisetron J1626, aprepitant J0185, dexamethasone J1100) are each separately billable with their own drug J-code and injection/infusion administration code. IV hydration (96360/96361) generates additional revenue on virtually every infusion day. For a 20-patient suite: $280–$340 missed per infusion day × 60 infusion days/month = $16,800–$20,400/month.
Oncology drug J-codes are billed per specific unit (per 1mg, per 10mg, per 100mg). When the billing team doesn't verify actual administered dose, they frequently submit fewer units — either from rounding down, using the ordered dose instead of actual administered dose, or not converting from mg/m² BSA-based dosing to total administered mg. J9271 (pembrolizumab, $90/mg) — billing 195mg instead of 200mg = $450 per infusion under-coded.
The most catastrophic per-claim denial: a high-value drug claim submitted without a valid prior authorization number, with an expired PA, or with the wrong PA number results in complete denial of the drug J-code. For pembrolizumab ($18,000/infusion) or ipilimumab-nivolumab ($82,320), a single PA-related denial eliminates the highest-value item on the claim. PA denials require appeals that take 60–120 days with no guaranteed outcome.
The most commonly missed revenue stream in radiation oncology: 77427 (weekly radiation treatment management) is billable for every 5 radiation fractions delivered — requiring a documented physician evaluation once per week during active radiation treatment. For a standard 30-fraction course: 77427 × 6 = $1,272 per patient course. For 100 patients annually: $127,200/year from one billing code that requires no additional physician work.
Using personal history codes (Z85.x) for patients currently receiving active cancer treatment — or using a primary malignancy code without correct staging, laterality, or site specificity — generates payer edits, medical necessity denials, and OIG audit risk. A patient receiving pembrolizumab for active Stage III NSCLC must be coded with C34.11, not Z85.118. The ICD-10 on the immunotherapy claim must match the diagnosis on the prior authorization exactly.
Oncology ICD-10 coding requires precision beyond any other specialty — primary malignancy site with anatomic specificity, laterality (right vs. left for paired organs), metastatic sites as secondary diagnoses, encounter type, and complication codes. Every imprecision creates a payer edit, a medical necessity review, or a PA indication mismatch.
NSCLC requires anatomic site (upper lobe, lower lobe, main bronchus), laterality (right vs. left), and morphology differentiation. Metastatic sites coded as secondary diagnoses (C77–C79 series) are required when present — bone metastases (C79.51), brain metastases (C79.31), adrenal metastases (C79.70).
Breast cancer ICD-10 requires anatomic quadrant, laterality (right vs. left), and receptor status coding for hormone receptor (Z17.0/Z17.1 ER status) and HER2 status. Stage IV breast cancer with metastases requires both the primary code and all metastatic site codes on every treatment encounter.
Colorectal cancer ICD-10 requires anatomic segment, and molecular status coding is critical for targeted therapy — RAS wildtype (required for cetuximab/panitumumab PA), BRAF V600E mutation (for encorafenib), and MSI-H status (for pembrolizumab). All secondary malignancy sites must be present on every infusion claim.
Hematologic cancer ICD-10 requires specific disease classification and disease status coding (in remission, not having achieved remission, relapsed, refractory). The disease status on the ICD-10 code must match the clinical state documented in the record — active disease vs. remission determines the encounter type and medical necessity justification.
The encounter type code determines whether an oncology visit is billed as an active treatment encounter or a surveillance visit. Z51.11 (antineoplastic chemotherapy) must be on all chemo infusion claims. Z51.12 (antineoplastic immunotherapy) must be on immunotherapy claims. Z08 (post-treatment follow-up) is for surveillance — never for active treatment visits.
Chemotherapy and immunotherapy complications generate separate ICD-10 codes that support additional E&M complexity and separate procedure codes for managing the complication. Immune-related adverse events (irAEs) from checkpoint inhibitors — pneumonitis (J70.2), colitis (K52.1), hepatitis (K71.51) — each support high-complexity E&M visits and steroid management coding.
Infusion hour sequencing, drug J-code management, prior authorization lifecycle, ICD-10 oncology specificity, radiation treatment management billing, surgical oncology add-ons, E&M complexity optimization — all in one specialized oncology billing partnership.
Every infusion encounter coded with the correct hierarchy — primary drug (96413), sequential drugs (96417), add-on hours (96415), concurrent non-chemo (96368), and IV push codes — applied per the actual administration sequence documented in the nursing record.
Every oncology drug J-code submitted with verified dose quantity, correct billing unit, active prior authorization reference — pembrolizumab, nivolumab, rituximab, trastuzumab, daratumumab, bevacizumab, and all other high-value infusion agents managed per protocol.
Complete prior authorization management for all high-cost oncology drugs — initiation, biomarker documentation compilation, approval tracking, PA number-to-claim linkage, renewal scheduling, and expedited appeal management for PA denials.
Complete radiation billing — treatment delivery codes (77385/77386), weekly treatment management (77427), simulation, dosimetry, planning professional component, and brachytherapy codes submitted with correct technical and professional component splits.
Precise oncology ICD-10 coding — primary malignancy with site specificity, laterality, metastatic sites, encounter type, molecular status, and treatment complication codes ensuring PA indication matching and payer medical necessity compliance on every claim.
Complete operative claim coding — primary tumor resection, sentinel node biopsy (two-part billing), immediate reconstruction, intraoperative pathology, modifier application, and robot-assisted surgery code pathways for all oncologic surgical procedures.
These recoveries came from billing what was already being administered — completely, correctly, with every code that was always billable and simply never submitted.
"I have 22 patients on pembrolizumab Q3W — every one of them a $18,000 drug J-code per infusion day. My previous billing submitted J9271 on each claim but missed the infusion administration codes, pre-medication codes, and E&M complexity on half of the encounters. After ParaMed's audit: we were leaving $548 per pembrolizumab infusion day on the table across 220 annual infusion days. That's $120,560 per year from patients who were already scheduled, already infused, already doing great clinically. The billing was just incomplete. ParaMed fixed it in 30 days."
"Our practice has a 6-chair infusion suite running 5 days a week. We were billing one infusion code per patient per day — 96413 and the drug J-code. ParaMed's audit showed us we were missing 96415 add-on hours on every multi-hour infusion, missing 96417 on every multi-drug regimen, and missing all pre-medication and hydration codes on every FOLFOX, CHOP, and carboplatin-paclitaxel day. Combined across our infusion suite volume: $47,280 per month in unbilled infusion administration codes. $567,360 per year. From codes that were always supported and always billable. We just never knew to submit them."
"I'm a radiation oncologist. My previous biller knew the treatment delivery codes — 77385 and 77386. What they didn't know: 77427 (weekly management, $212 per 5 fractions), 77014 (CT guidance per fraction, $188 when documented), and the treatment planning professional component (77263-26, $448). Weekly management alone: 77427 × 6 weeks × 120 patients = $152,640/year I wasn't billing. CT guidance on 80% of my IMRT patients: $188 × 0.8 × 30 fractions × 120 = $541,440 in CT localization I was delivering and documenting but not submitting. ParaMed identified $694,080 in annual recoverable revenue from 3 codes."
The most important questions oncologists and practice managers ask before transitioning to specialized oncology billing.
The oncology revenue gap is not a volume problem. It's a billing completeness problem. Every infusion hour after the first has a code. Every sequential drug has a code. Every pre-medication has a code. Every hydration bag has a code. Every weekly radiation management visit has a code. A ParaMed audit finds every dollar in 30 days — with zero disruption to your practice and zero obligation until you see the numbers.
Every high-value drug your practice administers reviewed — pembrolizumab, nivolumab, rituximab, trastuzumab, daratumumab. Current J-code submission rate, dose coding accuracy, and annual revenue gap calculated per drug.
Current 96413/96415/96417 capture rates reviewed. Add-on hours, sequential drug codes, pre-medication billing, and hydration billing gaps quantified across your infusion suite volume.
Active PA calendar reviewed for all high-cost drug patients. PA expiration risks identified. Denial rate on drug J-code claims analyzed. PA-to-claim matching process evaluated.
No obligation. No billing disruption. Audit delivered in 30 days. HIPAA compliant.
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