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Oncology billing services · Infusion · Radiation
PhysiAssist runs oncology medical billing and revenue cycle management for medical oncology and hematology practices, infusion centers and radiation oncology, plus oral oncolytics. CHONC-certified coders code every chemotherapy and infusion claim, RegimenIQ checks units, waste and authorizations against the regimen, and you see the margin on every drug before the claim goes out.
Illustrative example with sample data
The basics
Oncology billing services manage the revenue cycle of a cancer practice: benefits checks and prior authorization for each regimen, coding of visits, chemotherapy and infusion administration and drug units, radiation oncology course billing, claim submission, payment posting, denials and AR follow-up. Because oncology drugs are bought and billed by the unit, good oncology billing also tracks waste and the margin on every drug.
E/M with modifier 25, the infusion hierarchy, drug units by HCPCS, JW/JZ lines and the cancer diagnosis on every drug.
Start and stop times, sequential and concurrent infusions, biologics and biosimilars, site-of-care rules by payer.
Planning, simulation, dosimetry, delivery and weekly management, billed in order with the right technical and professional split.
Benefits investigation, prior authorization, specialty pharmacy hand-off and copay assistance, so patients start on time.
RegimenIQ · oncology revenue cycle management
Buy-and-bill only works when every drug is paid for what it cost. RegimenIQ checks each claim against the regimen and shows what each drug earns after acquisition cost, what was discarded and billed, and where a payer-approved alternative would hold up your margin. The treatment decision always stays with the physician.
Drug revenue
$1.86M▲ 6.2%Average drug margin
6.4%▲ 1.1 ptsWaste billed (JW)
$14.2Kevery discarded doseAuths ending in 14 days
7renewals sent| Drug · dose | HCPCS × units | Paid | Cost | Margin per dose |
|---|---|---|---|---|
| Pembrolizumab 200 mg | J9271 × 200 | $11,640 | $10,980 | |
| Bevacizumab-awwb 400 mg | Q5107 × 40 | $2,590 | $1,860 | |
| Bevacizumab 400 mg | J9035 × 40 | $3,180 | $2,960 | |
| Oxaliplatin 160 mg | J9263 × 320 | $95 | $40 | |
| Carboplatin 600 mg | J9045 × 12 | $110 | $70 |
| Drug · vial | Dose given | Billed (given) | Billed (discarded) | Modifier |
|---|---|---|---|---|
| Oxaliplatin · 200 mg vial | 160 mg | J9263 × 320 | J9263 × 80 | JW line added |
| Pemetrexed · 2 × 500 mg vials | 900 mg | J9305 × 90 | J9305 × 10 | JW line added |
| Bortezomib · 3.5 mg vial | 2.6 mg | J9041 × 26 | J9041 × 9 | JW line added |
| Pembrolizumab · 2 × 100 mg vials | 200 mg | J9271 × 200 | None | JZ set |
Ordered
Bevacizumab · J9035Commercial plan: step-therapy exception needed · margin $220 per dosePayer-preferred, already approved
Bevacizumab-awwb · Q5107No extra authorization · margin $730 per dose · +$510 per doseAlso on this payer's list
Bevacizumab-bvzr · Q5118Approved with the same authorization · margin $640 per doseShown to the physician as options with each payer's coverage. The prescribing decision is always clinical.
Illustrative view with sample prices and margins. Your view shows your own drugs, payers and contract rates.
Free drug-unit and regimen audit
Send us a recent month of chemotherapy and infusion claims. A CHONC-certified coder checks every drug line against the regimen and sends a written report you keep, whether or not you work with us.
Drug lines reviewed
412Lines with an issue
37Dollar impact
$21,480What the report covers
What we check
| Codes | What they cover | What we check |
|---|---|---|
| 96413 · 96415 · 96417 | Chemotherapy IV infusion: first hour, each additional hour, each sequential drug | One initial service per encounter, start and stop times, and which drug was the primary reason for the visit |
| 96365–96368 · 96374–96375 | Hydration, therapeutic infusions and pushes given with chemotherapy | Sequential versus concurrent, minimum times, and pushes under 16 minutes |
| 96416 · 96521 | Pump started for a prolonged infusion, and pump refill | The pump episode on the right date and the disconnect visit |
| J9000–J9999 · Q5101+ | Chemotherapy drugs and biosimilars, billed by HCPCS unit size | Units from the dose given, NDC on the line, and the cancer diagnosis linked to each drug |
| JW · JZ | Discarded drug from single-dose containers, or none discarded | A JW line for every discarded amount and JZ when nothing was discarded |
| 99211–99215 + 25 | Office visit on a treatment day | A separately identifiable visit, documented apart from the infusion |
Radiation oncology billing
Each step has its own codes, frequency limits and technical and professional split. We build the course once and bill every step against it.
Simple, intermediate or complex clinical planning, billed once per course.
Simulation level matched to the plan, with repeat simulations only when documented.
3D or IMRT planning, isodose, devices and physics consults, with bundling rules applied.
Daily delivery and weekly treatment management, counted every five fractions.
Where we work
We run billing today for oncology practices in Washington, from community oncology to infusion suites. Our team works inside your system, so nothing about your clinical workflow changes.
The systems we work in every day
We log in to your system; nothing about it changes for your team.
Claims, rejections and remittances worked through your clearinghouse.
Submissions, status checks and renewals in each payer's own portal.
Pricing
One rate of 2.8% to 5% of net collections, quoted in writing before you sign. Where you land depends on monthly collections, specialty mix, the scope of services, and your AR backlog and payer mix.
The rate covers medical coding, claim submission, payment posting, denials and AR follow-up. Front desk services, prior authorization, the reporting dashboard, patient statements, credentialing and digital marketing are quoted separately.
Estimate your rate →Benefits checks and prior authorization for each regimen, charge capture from the treatment plan, coding of E/M, chemotherapy and infusion administration, drug units and waste modifiers, radiation oncology course billing, claim submission, payment posting, denial management and AR follow-up, and drug margin reporting.
One chemotherapy visit can carry several drugs billed by the unit, an infusion hierarchy (initial, additional hour, sequential, concurrent, push), JW or JZ waste modifiers, and an authorization that covers only some cycles. Drug claims are also expensive, so one unit or modifier error can cost thousands of dollars.
For drugs from single-dose containers, Medicare requires JW on a separate line for any amount discarded, and JZ when none was discarded. JZ has been required on Part B claims since July 1, 2023. We set the right modifier on every drug line before the claim goes out.
Yes. We bill the full course: consultation, clinical treatment planning (77261–77263), simulation (77280–77290), dosimetry and physics, treatment delivery and weekly treatment management (77427, per five fractions), with the professional and technical split your setting requires.
Yes. For oral cancer drugs we run the benefits investigation, the prior authorization, specialty pharmacy coordination and copay assistance or foundation applications, so patients can start on time.
RegimenIQ is our oncology software. It checks each claim against the regimen: drug units, waste, authorization coverage by cycle and the diagnosis link, and it shows the margin on each drug and the payer-preferred alternatives for the physician to review. It comes with our oncology billing service.
PhysiAssist charges 2.8% to 5% of net collections, quoted in writing before you sign. Collections volume, specialty mix, scope, AR backlog and payer mix decide where you land.
We review recent chemotherapy and infusion claims and send a written report: unit errors by drug, missing or wrong JW/JZ lines, infusion hierarchy errors, authorization gaps by cycle, missed charges, and the dollar impact of each.
A free drug-unit and regimen audit by a CHONC-certified coder, with a written report you keep.