Oncology CPT Codes and Modifiers for 2025
May 19, 2025
Oncology billing is complex, involving consultations, chemotherapy administration, radiation therapy, infusions, and extensive patient management. Using the correct Oncology CPT codes and modifiers for 2025 ensures practices receive appropriate reimbursement while maintaining compliance in a highly regulated specialty.
Evaluation & Management (E/M) Codes for Oncology
| CPT Code | Description |
|---|---|
| 99202–99205 | New patient office visits (levels 2–5) |
| 99212–99215 | Established patient office visits (levels 2–5) |
| 99221–99223 | Initial hospital care |
| 99231–99233 | Subsequent hospital care |
| 99238–99239 | Hospital discharge services |
| 99497 | Advance care planning (first 30 minutes) |
Chemotherapy and Therapeutic Infusions
| CPT Code | Description |
|---|---|
| 96413 | Chemotherapy infusion, initial, up to 1 hour |
| 96415 | Chemotherapy infusion, each additional hour |
| 96409 | Chemotherapy IV push, single drug |
| 96411 | Chemotherapy IV push, additional drug |
| 96401 | Chemotherapy subcutaneous/intramuscular administration |
| 96365 | Therapeutic infusion, initial hour |
| 96366 | Therapeutic infusion, additional hour |
| 96367 | Therapeutic sequential infusion, additional drug |
| 96375 | Therapeutic IV push, sequential substance |
Radiation Oncology Codes (Basics)
| CPT Code | Description |
|---|---|
| 77261–77263 | Radiation therapy planning (simple to complex) |
| 77427 | Radiation therapy management, 5 treatments |
| 77300 | Basic radiation dosimetry calculation |
| 77412 | Radiation treatment delivery, complex |
Oncology Modifiers
| Modifier | Description |
|---|---|
| -25 | Significant, separately identifiable E/M service |
| -59 | Distinct procedural service |
| -76 | Repeat procedure by same provider |
| -91 | Repeat clinical diagnostic test |
| -JW | Drug wastage reporting |
| -JG | 340B drug pricing |
| -26 | Professional component only |
| -TC | Technical component only |
Common ICD-10 Codes in Oncology
| ICD-10 Code | Description |
|---|---|
| C50.911 | Breast cancer, right side |
| C34.91 | Lung cancer, unspecified site |
| C61 | Prostate cancer |
| C20 | Rectal cancer |
| Z51.11 | Encounter for chemotherapy |
| Z51.12 | Encounter for immunotherapy |
| D05.1 | Lobular carcinoma in situ of breast |
Oncology Billing Tips for 2025
Final Thoughts
Billing for oncology services requires careful attention to sequencing, time documentation, and medication administration rules. Mastering Oncology CPT codes and modifiers for 2025 ensures your practice stays audit-ready and financially healthy while continuing to provide life-saving care.
For informational purposes only.
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