Oncology billing is on the verge of undergoing a sea change in 2025 as cancer therapies make advancements in leaps and bounds, payment models change, and state-of-the-art technologies become part of the process. Cancer treatment is getting more complex and expensive. Some experts predict that global spending on cancer drugs will increase at a compound annual growth rate (CAGR) of 12.7% to reach $401.4 billion by the end of 2029. So, the billing world needs to keep up to stay precise, productive, and in line with rules.
For oncology clinics and their department handling revenue cycle management, understanding these trends is crucial for maximizing reimbursements and maintaining financial viability.
Key Trends Shaping Oncology Billing in 2025
1. Integration of AI and Automation in Billing Processes
Artificial intelligence (AI) and automation are revolutionizing oncology billing by streamlining coding, claims submission, and denial management. AI-powered coding tools enhance accuracy by automatically identifying appropriate diagnosis and procedure codes, reducing human error and speeding up the billing cycle. Automation also helps manage complex billing scenarios associated with personalized medicine, where genetic testing and targeted therapies require precise documentation and coding.
This technological shift enables oncology clinic’s billing teams to focus more on patient care quality rather than operational burdens. By reducing manual tasks, practices can improve efficiency and reduce claim denials, ultimately enhancing cash flow and financial stability.
2. Value-Based Care and Bundled Payment Models
The evolution from fee-for-service care to value-based care continues to have an impact on oncology billing in 2025. Under a value-based care structure, reimbursements are based on patient outcomes and scores related to quality measures, not the amount of services provided. This transition results in a requirement for sophisticated billing structures that can report on quality alongside service codes, and serve bundled payments associated with an episode of care.
Such accountable care organizations and risk-sharing agreements are more complex, especially since they require transparent and careful reporting, and encourage partnerships between the clinical and billing teams. Oncology practices moving toward these models will align financial assistance based on improving patient outcomes and cost-effectiveness.
3. Advances in Coding Reflecting New Therapies
One of the most important changes in oncology billing is the addition of new diagnosis and procedure codes derived from the latest treatment advancements. For example, during the 2025 ICD-10-CM update, a whole new category of diagnosis codes for lymphoma remission was added with over 35 codes, providing claims submissions with more accuracy and organizations with the ability to track patient outcomes better.
Additionally, CAR T-cell therapy, a landmark treatment for cancer patients, now has four new category I codes (38225-38228) for harvesting (38225), preparing (38226), receiving (38227), and administering (38228) CAR T-cells, which replace prior category III codes. These additions will allow oncology practices to report the services provided in an accurate manner, and ultimately help reduce claim denials and improve reimbursement rates.
4. Increase in Outsourcing Oncology Billing Services
Due to the complexity and changing nature of oncology billing, many practices are outsourcing their revenue cycle management to specialty providers. The reasons for outsourcing include gaining industry expertise, reducing administrative burden, and improving the accuracy and timeliness of claims.
RCM Workshop is an example of a provider that offers specialized custom medical billing services with trained billers and coders who are up-to-date on best practices, coding updates, and payer requirements to support maximum reimbursement and compliance.
5. Focus on Patient Financial Experience and Transparency
Patients are increasingly requesting transparency regarding costs within healthcare. In this current year, transparency will be recognized as the establishment of easy-to-understand bills prioritizing patients’ ability to pay and giving patients multiple payment options. Many providers have set up patient portals for patients to look at their bills, verify their insurance, and pay their bills online. These services have increased patient engagement and satisfaction.
Regulatory mandates on price transparency have led to the creation of more advanced price estimation tools. Patients are now able to estimate their out-of-pocket costs based on their insurance. This leads to the trust customers want and decreases disputes over billing.
Oncology billing is evolving in numerous ways in 2025, with advancements and challenges facing the profession – from coding updates for new therapies and innovations to the understanding and use of value-based care and technology. Practices that are willing to adapt to these changes, experience increased revenues, improved patient experiences, and more effective practice management while navigating multiple complex challenges in healthcare.
At RCM Workshop, we aim to provide unparalleled revenue cycle management services to oncology providers. Our team of experts will ensure that you receive your maximum, timely reimbursements so you can turn your attention back to patient care. Come learn how our oncology billing services can support your practice for growth and sustainability.
