Oncology billing services specialized medical billing services designed for healthcare providers who treat cancer patients. Cancer treatments often involve expensive medications, tests, and procedures. There are frequent updates to coding systems and insurance regulations. Accurate and thorough documentation is essential for proper reimbursement. That is why Oncology billing services ensure that claims coded and submitted correctly, leading to fewer denials and faster reimbursements.
Billing Care Solutions Services
Medical Billing & Coding:
Billing Care Solutions team stays up-to-date on the latest oncology-specific coding guidelines, ensuring accurate reimbursement for even the most complex treatments.
Revenue Cycle Management (RCM):
Billing Care Solutions optimize every step of the billing process, from eligibility verification and prior authorization to claim submission and collections. This reduces administrative costs and maximizes revenue capture.
Account Receivable Management:
Billing Care Solutions dedicated team ensures timely follow-up and collections for outstanding balances, improving your cash flow.
Provider Enrollment & Credentialing:
Biling Care Solutions handle the complex process of enrollment and credentialing with major insurance payers, saving you valuable time and resources.
Eligibility & Benefit Verification:
Billing Care Solutions proactively verify patient insurance coverage and benefits before treatment, minimizing surprises and maximizing upfront collections.
Authorization and Referral Services:
Billing Care Solutions team navigates the complexities of prior authorization requirements, ensuring timely approvals for necessary treatments.
Business Intelligence Reporting Services:
Billing Care Solutions provide customized reports that give you valuable insights into your billing performance, allowing you to identify areas for improvement and make data-driven decisions.
Patient Support:
Billing Care Solutions dedicated patient support team is available to answer any questions and address any concerns your patients may have regarding billing and insurance.
Types Of Codes
ICD-O Codes (International Classification of Diseases for Oncology):
These codes identify the specific type of cancer a patient has, including the site, behavior (benign or malignant), and morphology (cell type).
Range: ICD-O uses alphanumeric codes with a hierarchical structure. The first three characters represent the primary site, followed by additional characters for laterality, behavior, and morphology.
Example: C18.9 (Malignant neoplasm of the colon, unspecified behavior)
HCPCS Codes (Healthcare Common Procedure Coding System):
These codes identify specific medical services and procedures performed by healthcare providers. In oncology, HCPCS codes are crucial for billing procedures like chemotherapy administration, radiation therapy, and surgical interventions.
Range: HCPCS codes are five-character alphanumeric codes. The first four characters are identical to the CPT code (Current Procedural Terminology), with a fifth character added to differentiate specific services within a CPT code.
Example: 96400 (Chemotherapy, intravenous or intrathecal administration)
CPT Codes (Current Procedural Terminology):
These codes define specific medical services and procedures, often serving as the foundation for HCPCS coding in oncology. While HCPCS adds a fifth character for specific details, the first four characters of an HCPCS code will match the corresponding CPT code.
Range: CPT codes are five-character numeric codes.
Example: 96400 (Chemotherapy, intravenous or intrathecal administration) (This is the base code for HCPCS code 96400)
Place of Service Codes (POS):
These codes specify the location where a service was rendered. In oncology, these codes might identify inpatient vs outpatient settings for treatment administration.
Range: POS codes are typically two-digit numeric codes. Common examples include:
- 11 – Office
- 22 – Outpatient Hospital
- 49 – Home
Modifiers
59 – Distinct Procedural Service:
This modifier indicates that two or more separately identifiable services were performed during the same encounter. It’s often used when a consultation and a chemotherapy administration occur on the same day.
25 – Separate Evaluation and Management Service by the Same Physician on the Same Day of the Procedure:
This modifier indicate a separate E/M service (evaluation and management) is provided on the same day as a minor procedure, such as a biopsy or port placement.
51 – Multiple Procedures:
This modifier indicates that multiple unrelated procedures performed during the same encounter. It’s rarely used in oncology as most oncology procedures are related to the cancer diagnosis and treatment.
52 – Reduced Services:
This modifier signifies that a service partially performed or was significantly less than the typical service.
53 – Increased Services:
This modifier indicates that a service was more extensive than typically performed.
26 – Professional Component Only:
This modifier indicate professional component of a service (physician work) billed. The technical component (facility charges) would be billed with a separate HCPCS code.
TC – Technical Component Only:
This HCPCS modifier (not CPT) signifies that only the technical component of a service (facility charges) billed. The professional component would be billed with a separate CPT code and modifier 26.
AA – Subsequent Encounter:
This modifier indicate subsequent evaluation and management services related to an established diagnosis. It’s commonly used for follow-up visits after an initial cancer diagnosis.
AD – Admitting Diagnosis:
This modifier identifies the principal diagnosis that necessitated the patient’s admission to a hospital setting. It’s relevant for inpatient oncology care.
G0 – Preventive Medicine Service:
Certain preventive services related to cancer risk assessment or detection might utilize G modifiers.
In conclusion, Billing Care Solutions team experienced medical billing and coding specialists, takes the burden of billing off your shoulders. We handle the entire revenue cycle, from accurate coding and claim submission to managing denials and ensuring timely payments. This allows you and your staff to dedicate more time to what matters most – providing exceptional care to your patients.
We specialize in Medical Billing and Coding and provide comprehensive support for your practice. For more information visit
For more details on billing softwares, visit