Radiation Oncology Medical Billing & Credentialing Services

Radiation Oncology billing requires specialized expertise in complex treatment delivery coding, image guidance documentation, and strict regulatory compliance standards that general medical billing services cannot adequately address. Radiation oncology practices including hospital-based cancer centers, freestanding radiation facilities, academic medical centers, and community oncology programs face unique revenue cycle challenges such as frequent claim denials, devastating Medicare payment reductions exceeding 23% over the past decade, varying payer policies regarding intensity-modulated radiation therapy medical necessity, and intricate episode-based payment model transitions affecting reimbursement sustainability. Pro Health Care Advisors delivers comprehensive radiation oncology billing solutions designed for small to mid-sized radiation therapy practices seeking accurate claims processing, reduced denial rates, improved cash flow, and expert guidance navigating the evolving regulatory landscape governing radiation treatment services reimbursement.

Understanding Radiation Oncology Billing Complexities

Radiation oncology billing differs substantially from other medical specialties due to treatment delivery spanning multiple weeks requiring daily fraction billing, bifurcated coding structures separating hospital outpatient from freestanding facility reporting, and bundled payment proposals threatening traditional fee-for-service models that directly determine reimbursement structures. Treatment delivery codes include conventional radiation therapy 77401-77417 based on complexity levels, intensity-modulated radiation therapy using hospital codes 77385-77386 versus freestanding G-codes G6015-G6016, stereotactic radiosurgery 77371-77373, and image-guided radiation therapy consolidated into CPT 77387 beginning 2026 replacing previous guidance codes.

Radiation oncology suffered 25% Medicare payment reductions under physician fee schedule cuts since 2021, with 2025 conversion factor decreases compounding financial strain as operational expenses including linear accelerator maintenance, dosimetry systems, and specialized physics staff continue rising dramatically. Pro Health Care Advisors implements systematic quality assurance protocols identifying documentation gaps including incomplete simulation records, missing treatment management weekly documentation, absent professional component attestations for image guidance review, and insufficient medical necessity justification before claim submission, preventing costly denials and audit vulnerabilities.

Comprehensive Billing Services for Radiation Oncology Providers

Expert Coding for Treatment Planning and Simulation

Our specialists ensure accurate code selection for clinical treatment planning using 77261 for simple planning, 77262 for intermediate complexity, 77263 for complex planning, and three-dimensional conformal simulation coded 77295 requiring comprehensive documentation supporting complexity level selection and treatment planning medical necessity.​

IMRT and IGRT Treatment Delivery Billing Optimization

Intensity-modulated radiation therapy requires site-of-service specific coding using 77385 simple IMRT and 77386 complex IMRT for hospital outpatient settings versus G6015 and G6016 for freestanding centers, while image guidance beginning 2026 consolidates to 77387 requiring daily physician review documentation supporting professional component billing.

Treatment Management and Weekly Assessment Claims

Pro Health Care Advisors manages treatment management codes 77427 for one or two fractions weekly and 77431 for three or more fractions requiring comprehensive documentation of patient assessment, treatment response evaluation, side effect management, and coordination activities supporting weekly management medical necessity.

Stereotactic Radiosurgery and Specialty Technique Billing

Stereotactic body radiation therapy coded 77373 and cranial stereotactic radiosurgery using 77371-77372 require precise documentation distinguishing single-fraction versus multi-fraction treatments, comprehensive target delineation, and quality assurance procedures supporting specialized delivery technique complexity.​

Strategic Denial Management Reducing Revenue Loss

Radiation oncology practices experience substantially higher denial rates than other specialties due to insufficient treatment planning documentation lacking complexity justification, missing weekly treatment management documentation for billing 77427 or 77431, incomplete professional component attestations for image guidance review, and inadequate medical necessity documentation supporting advanced techniques including IMRT and stereotactic treatments. Common denial triggers include treatment management billed before fifth fraction delivery causing premature submission rejections, image guidance claims without documented physician review prior to subsequent treatments, technical component billing errors using wrong site-of-service specific codes, and claims submitted without comprehensive simulation documentation supporting treatment planning complexity levels.

Our denial management system tracks patterns specific to radiation oncology billing including Medicare scrutiny distinguishing conventional radiation from IMRT medical necessity, documentation insufficient for complex planning codes 77263 without detailed heterogeneity corrections and multileaf collimator usage, and payment disputes regarding professional versus technical component splits when hospital technical services bill separately from physician professional interpretations. We implement corrective action plans addressing root causes, pursue appeals with payer-specific treatment records supporting delivery complexity and physician supervision documentation, and monitor net collection rates measuring effective reimbursement after contractual adjustments and payment reductions.

Revenue Cycle Solutions Beyond Claims Submission

ROCR Act Preparation and Episode-Based Payment Transitions

The bipartisan Radiation Oncology Case Rate Act 2025 proposes fundamental transformation from quantity-based per-treatment billing to patient-focused episode-based payments requiring practices prepare for hybrid billing approaches, obtain mandatory accreditation from ASTRO or ACR, and develop sophisticated risk management strategies handling 100% financial risk models. Episode-based payments demand comprehensive outcome tracking, care coordination documentation, and quality metric reporting demonstrating patient-centric care delivery supporting value-based reimbursement under proposed legislative reforms.

2026 Coding Changes and Revaluation Impact

CMS introduced significant radiation treatment delivery and image guidance coding revisions effective 2026, consolidating image guidance into single code 77387 and revaluing practice expense components across specialties potentially causing dramatic reimbursement shifts. Practices must understand billing process modifications, train staff on updated coding requirements, and model financial impacts ensuring operational adjustments maintain service accessibility particularly in underserved areas vulnerable to reimbursement inadequacy.

Prior Authorization Management for Advanced Techniques

Commercial insurers increasingly require prior authorization for stereotactic radiosurgery, proton beam therapy, and comprehensive IMRT treatments demonstrating clinical appropriateness before approving high-cost radiation modalities. Authorization delays postpone treatment initiation while disrupting cancer care timelines, requiring systematic tracking systems monitoring approval status and radiation oncologist peer-to-peer consultations supporting advanced technique medical necessity.​

Technology Integration with Treatment Management Systems

Modern radiation oncology billing requires real-time integration with oncology information systems capturing simulation data, daily treatment delivery records, dosimetry calculations, and physician supervision documentation supporting billing accuracy. Automated charge capture prevents revenue leakage from unbilled physics consultations or treatment planning services, flags incomplete weekly management documentation before claim submission, and tracks site-of-service specific code requirements optimizing revenue cycle efficiency.​

Partner with Specialized Radiation Oncology Billing Experts

Radiation oncology billing complexity demands dedicated expertise understanding treatment delivery coding nuances, episode-based payment transitions, and evolving Medicare fee schedule reductions affecting cancer care reimbursement.

Our specialized radiation oncology billing services deliver:

• Expert treatment planning and simulation coding with complexity level documentation
• IMRT and IGRT billing optimization using site-of-service specific code requirements
• Treatment management weekly assessment claims with comprehensive supervision documentation
• Stereotactic radiosurgery billing accuracy distinguishing single versus multi-fraction treatments
• ROCR Act preparation supporting episode-based payment model transitions
• Prior authorization management reducing advanced technique approval delays
• HIPAA-compliant systems protecting patient oncology information
• Monthly financial reporting with Medicare payment reduction impact analysis

Pro Health Care Advisors brings boutique service quality ensuring your billing team understands radiation oncology workflows, knows your payer mix challenges intimately, and advocates persistently for maximum reimbursement on every treatment fraction and planning service.