Hematology/Oncology

Hematology/Oncology is one of the most active Medicare specialties in the United States, represented by 4K providers across the country. The average Hematology/Oncology provider treats 152 Medicare beneficiaries and receives $235K in total annual Medicare payments, translating to $2K per patient — a figure that signals high-acuity care and complex case management.

Evaluation and Management coding patterns reveal how Hematology/Oncology providers characterize visit complexity. The dominant code is 99214 at 54.8% of E&M visits, reflecting moderate-to-high complexity encounters that are typical when managing established patients with multiple chronic conditions. Meanwhile, 99213 accounts for 20.3% and high-complexity 99215 visits represent 24.9% of the mix.

Care management program adoption presents a significant revenue opportunity for Hematology/Oncology practices. Chronic Care Management (0.9%), Remote Patient Monitoring (0.1%), Behavioral Health Integration (0.0%) remain substantially underutilized relative to the eligible patient population. Annual Wellness Visit adoption sits at just 0.2%, well below the 70% target — meaning a majority of eligible Medicare beneficiaries are not receiving this preventive service, and practices are missing a straightforward billing opportunity. Providers who implement these programs can unlock substantial per-patient monthly revenue while improving chronic disease outcomes — NPIxray can help identify exactly which patients qualify.