Please, enlighten the unfamiliar European.
What seems to be the issue?
-Are less busy clinics forced to close, because due to reimbursement cuts, the income of a less busy clinic, can no longer sustain its operations?
- Why exactly is there a gap between the quoted 1% cut and the experienced 10% cut?
~20 rad onc codes present for a decade or more got deleted Jan 2026. ASTRO/ACRO went to CMS and did a complete redefinition of standard external beam codes. IMRT was eliminated as a billable kind of thing except for the IMRT plan. Briefly, the three codes became:
Level 1: electrons and 2D (pays ~$150)
Level 2: single iso 3D or IMRT (pays ~$300)
Level 3: 2D/3D/IMRT multi-isocenter, or motion management, or combined photon electron, or total skin electron (pays ~$450)
Furthermore, each code definition contains the proviso "Includes image guidance." However, there is a new professional-only MD IGRT analysis code (pays ~$30).
Basically level 2 becomes the default most times.
Problem 1: Level 2 bills about 15% less than the old IMRT codes.
Problem 2: The new IGRT analysis code pays hospitals ~5% less for IGRT, but it pays freestanding clinics ~80% less than they had become accustomed to since ~2006.
Problem 3: prior authing the new codes with insurances is an occasional clusterf*ck because they don't have policies for the codes, but still try to deny IMRT e.g. (even though it's not a code)
Problem 4: the rad oncs in America who helped make the codes with the AMA and CMS had no experience with freestanding billing and didn't think any of this through very well it seems
Problems probably only Luigi Mangione can solve
