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Radiation Oncology Billing Services Billing & RCM Services
Where Radiation Oncology Revenue Slips Away: Unbilled Physics Work, Fraction-Count Errors, and Auth Denials on IMRT and SBRT. One course of IMRT can produce ten or more distinct billable codes, from the consult and clinical treatment planning through simulation, dosimetry, physics, treatment devices, daily delivery, image guidance, and weekly management. Qualigenix bills each of them from the treatment record, so the work your radiation oncologists, physicists, and dosimetrists do appears on the claim.
What is Radiation Oncology Billing?
Radiation oncology billing means coding every phase of a treatment course (planning, simulation, dosimetry, physics, delivery, image guidance, and weekly management) to the correct setting, with prior authorization that matches the approved plan and fraction count. Qualigenix's specialty coders bill for radiation therapy centers and hospital departments with a 98.2% first-pass clean claim rate on first submission, and 79% of the denials we appeal are overturned. Start with a free billing audit at 786-259-0231.
01
Coding Across Planning, Simulation, Dosimetry, and Delivery (772xx–774xx)
Radiation oncology codes sit in the 77261–77799 range, and each one depends on the step before it. Clinical treatment planning (77261–77263) is graded by complexity, simulation (77280–77290) by setup, and dosimetry and physics (77295–77370) by planning method. An unbilled 77300 basic dosimetry calculation or 77334 complex treatment device is revenue the practice earned and never collects.
02
Prior Authorization for IMRT, SBRT, SRS, Proton, and Hypofractionation Plans
Commercial and Medicare Advantage plans often send radiation therapy through a benefit manager that approves one technique and one fraction count. If the physician moves a patient from 3D conformal to IMRT or adds a boost, the original approval may not cover what is delivered.
03
Weekly Treatment Management and the Five-Fraction Rule (77427, 77431, 77435)
Code 77427 is billed once per five fractions, counted by fraction, not by calendar week. Under CPT rules, one or two fractions left at the end of a course are not billed separately, while three or four support one more unit. Courses of one or two fractions use 77431, SBRT uses 77435 per course, and SRS uses 77432. A miscount in either direction either loses revenue or creates an overpayment.
04
Hospital vs. Freestanding Billing: Global, 26/TC Splits, and G-Code Delivery
Medicare pays radiation delivery differently by setting. Hospital outpatient departments report delivery and image guidance with CPT codes such as 77385, 77386, 77402–77412, and 77387. Freestanding centers bill globally and report Medicare delivery and guidance with HCPCS G6001–G6017. The physician's professional services carry modifier 26 wherever the code has a professional component. Using the wrong code set for the setting gets the claim rejected.
05
Benefit Verification for Multi-Week Treatment Courses
A conventionally fractionated course can run six to eight weeks, and coverage can change inside that window: a plan year turns over, a patient ages into Medicare, or secondary coverage lapses. A single verification at consultation leaves the back half of the course unprotected.
06
Documenting the Treatment Plan, Physician Signatures, and Medical Necessity
Medicare contractors expect a signed treatment plan, a prescription that matches the delivered dose and fraction count, and a record of each weekly management visit. A CMS Medicare Quarterly Compliance Newsletter listed missing treatment plans and missing physician signatures among the errors found in radiation therapy claims.
07
Denials on IGRT Bundling, Duplicate Physics, and Missing Plan Records
The recurring radiation oncology denials are image guidance billed with a delivery code that already includes it under NCCI edits, continuing physics (77336) billed more than once per five fractions, special treatment procedures (77470) without supporting notes, and claims sent before the plan is signed.
08
Medicare Clinical Trial Billing and Supervision Rules
Clinical trial patients need routine costs separated from research costs. Medicare's clinical trial policy (NCD 310.1) covers routine costs in qualifying trials, and those claims carry the Q0 or Q1 modifier, diagnosis code Z00.6, and the trial's eight-digit NCT number. Treatment delivery also needs physician supervision at the level CMS assigns to each code.
PRECISION: WHAT QUALIGENIX DOES
How Qualigenix Closes Each Radiation Oncology Billing Gap
Qualigenix closes these gaps by billing each treatment course as one episode, from the consult note to the final fraction, with a coder assigned to radiation oncology.
Episode-Based Charge Capture From Consult to Final Fraction
We reconcile charges against the treatment record every week, so planning, physics, devices, and delivered fractions are counted before the claim goes out. Across our client base, the charge-entry error rate is 1.6%.
Auth Packets Built Around the Approved Plan and Fraction Count
Each authorization request goes in with the plan, technique, and fraction count. When the plan changes mid-course, we re-check the approval before the changed fractions are delivered.
Treatment-Management Counting and Physician Attestation Checks
We count fractions under the five-fraction rule and match every 77427 unit to a documented management visit by the treating radiation oncologist.
Site-of-Service and Component Billing Done Right the First Time
We assign CPT or G-code delivery by setting and payer, and split professional and technical components wherever the code allows it.
Course-Length Eligibility Checks Before Simulation
We verify benefits at consultation, again before simulation, and again at any plan-year change during treatment.
Plan, Prescription, and Signature Audits Before Claims Go Out
No claim leaves until the treatment plan is signed and the prescription matches the delivered dose and fraction count.
Appeals for Bundling and Medical-Necessity Denials
Our denial team overturns 79% of the denials it works, with an average appeal turnaround under 9 days. Each appeal cites the NCCI edit or Medicare contractor policy behind the claim.
Trial-Claim Separation (Q0/Q1, Z00.6, NCT Number) and Compliance Monitoring
We flag trial patients at registration, split routine from research charges, and audit trial claims for modifiers, diagnosis coding, and the NCT number before submission.
CASE STUDY 01
How a 3-provider podiatry group cleared $214K in aged A/R
THE SITUATION
A 3-provider podiatry group with roughly 60% Medicare payer mix carried $412,000 in A/R, 38% of it past 120 days. Routine foot care claims (11720, 11721, 11055–11057) had stalled on inconsistent Q7/Q8/Q9 modifiers and class-finding documentation, so payers held or partially paid and nobody worked the remainder. Medicare crossover to secondaries was not being posted, and small patient balances were written off.
WHAT QUALIGENIX DID
We ran a full A/R aging segmentation, worked claims by payer and denial reason rather than by date, rebilled the stalled routine-care claims with corrected modifiers, and reactivated secondary and crossover billing.
Key Outcomes & Turnaround
38% to 14%A/R past 120 days
$214,000recovered from aged A/R
90 daysto turn it around
~60%Medicare payer mix
Audited Practice Results
How a solo podiatrist lifted first-pass acceptance to 96%
THE SITUATION
A solo podiatrist coding 320 encounters a month was stuck at 82% first-pass acceptance. Routine foot care went out without the systemic-condition diagnosis pairing and class findings Medicare requires, so it read as non-covered. Wound debridement was coded to the wrong depth (11042 for skin and subcutaneous where the note supported 11043 for muscle and fascia). Same-day E/M with a procedure went out without modifier 25 and got bundled.
WHAT QUALIGENIX DID
We rebuilt the coding workflow: diagnosis-to-CPT pairing rules for at-risk foot care, correct Q-modifier logic, depth-based debridement coding tied to the operative note, and disciplined use of modifiers 25 and 59/XS.
Key Outcomes & Turnaround
82% to 96%first-pass acceptance
+11%per-encounter reimbursement
60 daysto turn it around
320/moencounters coded
Audited Practice Results
How a 2-location podiatry practice cut its denial rate by two-thirds
THE SITUATION
A 2-location podiatry practice sat at a 19% denial rate, mostly Medicare routine-foot-care and nail-debridement rejections. The denials clustered in three buckets: medical-necessity rejections on routine foot care (missing qualifying diagnosis and class findings), frequency-edit denials on nail debridement billed inside the 60-day window, and missing Q modifiers that flagged services as non-covered.
WHAT QUALIGENIX DID
We built a front-end denial-prevention layer, checking eligibility and coverage against payer LCDs before claims went out, plus a structured appeal workflow with documentation templates mapped to each denial reason.
Key Outcomes & Turnaround
19% to 6%denial rate
$68,000recovered on appealed claims
4 monthsto turn it around
2 locationspractice size
Audited Practice Results
Radiation Oncology Coding Matched to Each Phase of Treatment
Qualigenix codes radiation oncology by treatment phase, because each phase has its own code family and its own payer rules.
Consults and Treatment Planning
New and established patient visits, inpatient consults, and simple, intermediate, or complex clinical treatment planning, graded on the documented targets, modalities, and complexity.
COMPLIANCE
Keeping Radiation Oncology Claims Defensible
Qualigenix keeps radiation oncology billing compliant by coding to the signed treatment plan, counting fractions the way CPT and Medicare count them, and checking supervision and trial status before a claim is sent. Underbilling leaves earned revenue uncollected. Overbilling a physics code or a management unit creates an overpayment that an audit will find. Our coding work holds a 98.6% compliance and audit pass rate, with an over- and undercoding rate under 2%. All patient data is handled under HIPAA-compliant security controls.
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Audit Pass Rate
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Variance Threshold
Why Radiation Oncology Groups Choose Qualigenix
Our radiation oncology coders work from the full planning-to-delivery code chain and the Medicare contractor billing articles for radiation therapy. They follow payer and coding updates each year, so a code set change doesn't reach your claims as a denial.
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IMPROPER PAYMENT RATE
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FROM DOC GAPS
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FROM CODING ERRORS
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QUESTIONS BUYERS ASK
Frequently Asked Questions
Qualigenix prices radiation oncology billing after reviewing your claim volume, payer mix, and the services you want to hand over. Most radiation therapy centers start with a free billing audit so the quote reflects real numbers.
We bill 77427 once per five fractions, counted by fraction, not by calendar week. One or two fractions left at the end of a course are not billed separately, and three or four support one more unit.
We flag trial patients at registration, separate routine costs from research costs, and add the Q0 or Q1 modifier, diagnosis code Z00.6, and the trial's NCT number to every qualifying Medicare claim.
Yes. We work aged radiation oncology claims by denial reason and timely-filing limit, starting with the highest-value accounts. A free AR review shows how much is still recoverable.
We re-check the authorization as soon as the technique, dose, or fraction count changes and submit an updated request before the changed fractions are delivered. If you're seeing mid-course auth denials, a free billing audit will show where they start.
Yes. We bill Medicare delivery with HCPCS G-codes for freestanding centers and with CPT codes for hospital outpatient departments, with the physician's professional services carrying modifier 26 where it applies.
Qualigenix works across 133 EMR/EHR platforms, and we confirm access to your oncology information system, whether ARIA, MOSAIQ, or another system, during the free billing audit. We bill from your current system, so your staff keeps its existing workflow.
Qualigenix's average onboarding time is 6 days. That covers system access, payer enrollment checks, and coder assignment before we take over claim submission.