Hematology Billing & RCM Solutions
Comprehensive revenue cycle support for hematologists — from accurate blood disorder coding to infusion billing, prior auths, and appeals.
Our team supports practices treating leukemia, anemia, hemophilia, and related conditions. We manage CPT coding, HCPCS drug claims, and RAC audit protection. Improve claim accuracy and reduce payment delays with our hematology-focused billing specialists.
Schedule a Free ConsultationCoding for Complex Hematologic Conditions
We specialize in ICD-10 and CPT coding for hematologic diseases such as lymphoma, multiple myeloma, leukemia, sickle cell anemia, and bone marrow failure. Our coders document disease stage, risk classification, and chronicity to meet payer requirements and improve claim accuracy.
Infusion, Injectable & Biologic Therapy Billing
Our experts bill for high-cost hematologic therapies — including IVIG, iron infusions, monoclonal antibodies, and chemotherapy. We manage HCPCS drug units, dosage tracking, and administration time for compliant infusion claims.
Pre-Authorizations & Coverage Requirements
We handle prior authorizations for transfusions, injectables, and genomic tests. Our specialists upload clinical records, lab results, and staging documentation to meet payer medical necessity criteria.
- Eligibility and benefit verification
- Pre-certification for chemotherapy regimens
- Payer portal submissions and tracking
- Genetic testing coverage support
Denial Recovery & Audit Defense
Hematology claims often face RAC/MAC scrutiny. We respond to diagnosis mismatch denials, HCPCS unbundling issues, and missing documentation by submitting strong, medically supported appeals.
Common Denial Reasons:
- Drug dose units mismatch
- Missing infusion administration notes
- Invalid NDC or J-code combinations
- Non-covered genetic panels
Our Appeal Approach:
- Structured appeal letters with documentation
- Timely resubmission within payer windows
- NDC validation and crosswalk support
- Provider training on billing documentation
Modifier & HCPCS Unit Accuracy
Proper use of modifiers and HCPCS drug units is essential in hematology billing. We apply correct units and modifiers to prevent underpayments or payer denials.
| Code/Modifier | Usage | Example |
|---|---|---|
| JW Modifier | Drug wastage billing | IVIG partial vial use |
| -25 Modifier | Separate E/M visit on same day | Office visit + iron infusion |
| HCPCS Units | Accurate drug quantity reporting | J1756 billed in 1mg units |
What Hematologists Say
Dr. Arvind Patel
Midwest Hematology Group
"They streamlined our chemo and biologic billing — no more claim errors on drug units or modifier usage. A true billing partner for our specialty."
Sandra B., Practice Administrator
Valley Blood Disorders Clinic
"Their pre-auth turnaround times and audit handling saved our team hours each week. Claims now go through clean on the first submission."
Hematology Billing FAQs
Do you bill for both infusion and injection services?
Yes. We handle all chemotherapy, immunotherapy, and IV biologic billing using CPT 96401–96549, including proper sequencing of multiple administrations.
How do you ensure correct drug unit billing?
We follow CMS and commercial payer rules for unit conversion and drug NDC crosswalks, ensuring HCPCS units align with administered dosages. Wastage is billed with the JW modifier when applicable.
Can you help with genomic and specialty lab billing?
Absolutely. We support pre-auths and billing for molecular diagnostics and coagulation panels under hematology. We also help ensure CPT codes and documentation support medical necessity.