~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:
It's quite simple. Medicare is a giant entitlement program which has a budget that is inexorably spiraling out of control. To control costs, one lever is to slash reimbursement to physicians. Large, naked cuts are politically toxic. Therefore, government bureaucrats fundamentally alter the billing codes that will ostensibly slash reimbursement but gild it with soft language like, "more efficicient coding," "takes away the need for prior authorization," and "payment stabilization."
We need a $1.5 Trillion military budget, because Eric and Don Jr. hold multiple defense contracts and Sr. will need to handsomely bribe generals for loyalty when the military coup occurs before the election. Duh.
77412 for multiple isos for arthritis should not be difficult. It is being difficult because they are gaslighting us in a way that none of us should ever accept. It's absurd that people claim multiple isos is not completely clear and cut and dry.
Please do so. Just the delay to hold money in investment?
If they do this for one PSMA PET per day (presuming it costs them $5000) each day for a year and put the money in t-bills for 2 weeks, by my math they'll make $3000 or so a year in interest.
Yay. Pontifications for pontificating’s sake. What they’re saying may be useful from a Medicare standpoint; completely worthless bloviating from commercial insurance standpoint or even Med Adv. Will have to listen. But Ron is always doing more harm than good with his opinions.
I don't ascribe a nefarious "deny and invest" reason to the delay. It's a real banality of evil situation however. Let me make a few observations and lay out a few facts.
I mean ... logically, it should happen. But, despite too many of us, despite hypo-fx, despite declining indications, people seem to be doing okay. What makes you think it will be different in 2026? I generally would agree, but the fact that it really hasn't gotten much worse or seen job losses make me question breadline theory. I don't mind being wrong, but if wrong over and over, I am wondering where my reasoning is falling apart.
The ASTRO survey respondents said they had to fire physicians. Weren’t making payroll. Losing huge amounts of money. Closings contemplated.
Look at the comments in ATRO survey. ASTRO knows this and they say this in private meetings. People will lose their livelihood. Dont despair tho, PPS “nonprofits” stand by to help and consolidate even more. The plan is working as planned. You’re just not in it partner.
Must all be fake news from misanthropes then. Nothing to see here folks!
ASTRO has some people who truly care and have the heart in the right place. A battle of ideas is often fought but it is not always won. I did not fully understand it initially but non clinical people like Adler and others in ASTRO intelligentsia constantly shut down good bold ideas in favor of more “realistic” solutions. They may or may not be right in the end but you have to wonder. Society is growing tired of these moderate voices, the people who prefer the stagnancy of order instead of revolutionary bolder thinking. The people get restless. Pitchforks are always right around the corner.
I feel for those centers and their employees and their patients.
Even if there are some people in ASTRO who say they care, over the last two decades ASTRO has relentlessly pursued policies which dramatically harm freestanding centers while protecting large health systems.
If I’m understand what they are requesting, they want 77407 and 77412 to pay exactly the same.
“multiple isos” is not clear as day to the legion of RNs in America who are triaging rad onc prior auths (mostly because there is not a checkmark box for this on most prior auth forms yet afaik)
We even submit a separate document for multi iso cases to make this clear. I would not chalk this up to stupidity.
It isnt just academics. There are large community places like US Oncology, Advocate (basically new 21s C), etc which are nothing like the true stand alone center that may actually struggle. These are places building proton centers, etc. I don’t see it as only “academic” places but moneyed elite vs have nots.
My recent level 3 denial for arthritis got overturned on appeal.
Harder to find mom and pop freestanding centers kinda like Mom and pop med onc shops when you need 7 figures of capital to buy drugs before you start practicing
If it makes you feel any better I was doing a prior auth for Abiraterone the other day and the person on the phone asked me how to pronounce “metastasis”
That does not make me feel better
best news I've heard in weeks
Is it generic and 75$ a month at cost plus ?
So.... Could you?
