Infusion Therapy revenue cycle management
Infusion revenue is high-dollar and authorization-heavy - J-codes by NDC units, infusion time coding, drug wastage and site-of-care auth. AI agents capture every unit and clear every auth.
Infusion therapy bills high-cost drugs by NDC units, time-based infusion and hydration codes with sequential and concurrent rules, JW drug-wastage capture, and site-of-care prior authorization. MedXFlow supports drug and infusion coding, secures authorizations, and protects every dollar through posting and denials.
Drug & infusion billing
- J-code & NDC unit billing - Bills infused drugs with correct J-codes and NDC units so nothing is under-billed.
- Infusion & hydration time coding - Codes initial, sequential and concurrent infusion and hydration time correctly.
- Drug wastage (JW) capture - Captures discarded drug with the JW modifier so wastage is reimbursed.
Prior authorization
- Specialty-drug & site-of-care auth - Submits specialty-drug and site-of-care authorizations with documentation and tracks them.
Eligibility & benefits
- Medical & pharmacy benefit checks - Verifies whether the drug bills under the medical or pharmacy benefit before treatment.
Claims, posting & denials
- Underpayment detection - Flags underpayments against contracted rates on high-dollar drug claims.
- Denial management - Works authorization, unit and wastage denials by root cause.
What you get
- Every drug unit and wastage captured
- Infusion time coded correctly
- Site-of-care authorizations cleared
- Underpayments detected on high-dollar claims
Frequently asked questions
How is infusion therapy billed?
Infused drugs are billed with HCPCS J-codes by NDC units, plus time-based infusion and hydration administration codes that follow initial, sequential and concurrent rules. Discarded drug is captured with the JW modifier. Accurate unit and time capture is critical because the drugs are expensive.
Why are infusion claims denied?
Common reasons are missing site-of-care or specialty-drug authorization, incorrect NDC units, infusion time-coding errors, and un-captured wastage. Securing auth and capturing units correctly prevents most of them.