CPT coding changes - ASTRO

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BobbyHeenan

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I am seeing on this recent ASTRO blog some possible deletion/bundling of some codes.

I presume these are on the technical side, but does anyone know if these codes are being "deleted" also on the professional side? CBCT review (77014-26) is a chunk of professional revenue.

1740680169302.png


 
How do these changes impact the 70-80% of employed rvu based docs, many or whom work for large systems? If cms completely eliminated proffesional codes, I doubt salaries would change at these institutions (raking in 150k+ for prostate)given technical is so profitable and increasing at least 7% a year. (Hospital costs far outpace inflation)
If 20% of rvus are cut, hospitals would have to pay you 20% more per rvu if the market is efficient. If they don’t have to increase the dollars per rvu, this would testify to a worse oversupply than we thought. The distinction between technical and proffesional is very artificial for an employed doc, especially when dollars per rvus is adjusted to work backwards.
 
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RickyScott said:
How do these changes impact the 70-80% of employed rvu based docs, many or whom work for large systems? If cms completely eliminated proffesional codes, I doubt salaries would change at these institutions (raking in 150k+ for prostate)given technical is so profitable and increasing at least 7% a year.
If 20% of rvus are cut, hospitals would have to pay you 20% more per rvu if the market is efficient. If they don’t have to increase the dollars per rvu, this would testify to a worse oversupply than we thought. The distinction between technical and proffesional is very artificial for an employed doc, especially when dollars per rvus is adjusted to work backwards.
Click to expand...
New grads: lots of wisdom here
 
RickyScott said:
How do these changes impact the 70-80% of employed rvu based docs, many or whom work for large systems? If cms completely eliminated proffesional codes, I doubt salaries would change at these institutions (raking in 150k+ for prostate)given technical is so profitable and increasing at least 7% a year. (Hospital costs far outpace inflation)
If 20% of rvus are cut, hospitals would have to pay you 20% more per rvu if the market is efficient. If they don’t have to increase the dollars per rvu, this would testify to a worse oversupply than we thought. The distinction between technical and proffesional is very artificial for an employed doc, especially when dollars per rvus is adjusted to work backwards.
Click to expand...
I think it depends on structure. If you’re strictly productivity based and the code was eliminated, I imagine the hospital wouldn’t change a thing. If you’re on a productivity only model then you’re likely already making significantly more than the median salary, so no one will feel bad if you drop from say 800k to 650k but it’s gonna suck if it happens!
 
Bequerel said:
I think it depends on structure. If you’re strictly productivity based and the code was eliminated, I imagine the hospital wouldn’t change a thing. If you’re on a productivity only model then you’re likely already making significantly more than the median salary, so no one will feel bad if you drop from say 800k to 650k but it’s gonna suck if it happens!
Click to expand...

plenty of docs on productivity that aren’t anywhere near those numbers especially in saturated areas. Gonna be harder to justify their jobs or at least a job that pays well.
 
Codes are normally deleted when they're outdated and no longer used, but this is a high volume code for all of rad onc. Does anyone know the rationale for deletion??
 
Bequerel said:
I think it depends on structure. If you’re strictly productivity based and the code was eliminated, I imagine the hospital wouldn’t change a thing. If you’re on a productivity only model then you’re likely already making significantly more than the median salary, so no one will feel bad if you drop from say 800k to 650k but it’s gonna suck if it happens!
Click to expand...
RickyScott said:
How do these changes impact the 70-80% of employed rvu based docs, many or whom work for large systems? If cms completely eliminated proffesional codes, I doubt salaries would change at these institutions (raking in 150k+ for prostate)given technical is so profitable and increasing at least 7% a year. (Hospital costs far outpace inflation)
If 20% of rvus are cut, hospitals would have to pay you 20% more per rvu if the market is efficient. If they don’t have to increase the dollars per rvu, this would testify to a worse oversupply than we thought. The distinction between technical and proffesional is very artificial for an employed doc, especially when dollars per rvus is adjusted to work backwards.
Click to expand...

The market is not swift enough to respond quickly at least.

If that code gets cut and you're employed...sure, you can go to admin and ask them to adjust up the $/RVU....but majority will not and will be willing to test the waters as to what they can get away with paying.

This possible code cut should be getting way more attention than it is. As people are saying, this is like telling every rad on in the US they're about to take a 20%+ haircut overnight. If this really does apply to professional fees....This should be like a 5 alarm fire from ASTRO. My fear is rather than fighting it they will use it to push ROCR.
 
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HolySmokes said:
Codes are normally deleted when they're outdated and no longer used, but this is a high volume code for all of rad onc. Does anyone know the rationale for deletion??
Click to expand...

Exactly.

I'm *hoping* it's just tech fees since that code has been bundled/eliminated for IMRT cases for years ont he tech side.

I'm also hoping this isn't ASTRO manufacturing a need for ROCR.

On the pro side, I spend plenty of time checking films and it remains an important part of my job - we catch not only alignment but anatomic changes that need re-planned or clinical plan adjusted all the time.
 
BobbyHeenan said:
Exactly.

I'm *hoping* it's just tech fees since that code has been bundled/eliminated for IMRT cases for years ont he tech side.

I'm also hoping this isn't ASTRO manufacturing a need for ROCR.

On the pro side, I spend plenty of time checking films and it remains an important part of my job - we catch not only alignment but anatomic changes that need re-planned or clinical plan adjusted all the time.
Click to expand...
I agree about the market being slow to react in our case (simply because it can), but i can assure you that if a medonc or radiology code was cut, my hospital would adjust salaries immediately (they don’t want to loose them again) as a testament to supply and demand.
 
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Is it possible that 77014 will just be combined one/all of the 7704* codes? Same wRVU, fewer codes?
 
RickyScott said:
I believe our psychiatrists make at least 150/rvu. I

I agree about the market being slow to react, but i can assure you that if a medonc or radiology code was cut, my hospital would adjust salaries immediately (they don’t want to loose them again) as a testament to supply and demand.
Click to expand...

I hope that would be the case.

I am pro fee only, so this would really throw me for a loop.
 
BobbyHeenan said:
Exactly.

I'm *hoping* it's just tech fees since that code has been bundled/eliminated for IMRT cases for years ont he tech side.

I'm also hoping this isn't ASTRO manufacturing a need for ROCR.

On the pro side, I spend plenty of time checking films and it remains an important part of my job - we catch not only alignment but anatomic changes that need re-planned or clinical plan adjusted all the time.
Click to expand...
I'm doing a p2p later for daily imaging in the context of palliative rt for in field recurrent lung cancer. It's weird I have to ask in this specific context, but weirder still that there's an upstream narrative that it's not totally important we know where we aim in most contexts. I was trained by esteemed HN attendings who thought weekly kvs were good enough. This seems to be the approach for those in academics who trained 20 years ago. Higher risk for misadministration with lower risk of being able to prove it.

Oops, I'm older than I thought. 30 years ago.
 
BobbyHeenan said:
This possible code cut should be getting way more attention than it is. As people are saying, this is like telling every rad on in the US they're about to take a 20%+ haircut overnight. If this really does apply to professional fees....This should be like a 5 alarm fire from ASTRO. My fear is rather than fighting it they will use it to push ROCR.
Click to expand...

I agree, very frustrating blog post by ASTRO. Overly vague and loaded with uncertainty.

I don't see the point of conflating this change with ROCR except to try to use FUD to get people to support it. They are separate issues. ROCR doesnt even have a CBO score yet, it is not going to help with the 2026 rule.
 
NotMattSpraker said:
I agree, very frustrating blog post by ASTRO. Overly vague and loaded with uncertainty.

I don't see the point of conflating this change with ROCR except to try to use FUD to get people to support it. They are separate issues. ROCR doesnt even have a CBO score yet, it is not going to help with the 2026 rule.
Click to expand...

Yes - would like to see if someone at ASTRO could clarify here this pro vs. tech issue. I'm not an ASTRO member though.
 
77014 is not being deleted supposedly..
It is being integrated into the intermediate delivery code

Itermediate is all single iso 3D and IMRT
Complex is if using dibh or gating or sgrt or multi isos. SBRT will still be separate but I don't think it was being billed with that anyways
 
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I wonder why no one has mentioned that if IMRT treatment 77xxx codes are eliminated… does that eliminate the IMRT insurance company clinical guidelines (and all associated hassle)?

The observant among us will note that in Dec 2024 CMS deleted every IMRT LCD in existence except for one (covering TN, GA, AL, NC, SC, VA, and WV), but that one is not just an IMRT LCD, and it only came into existence in 2023.
 
medgator said:
77014 is not being deleted supposedly..
It is being integrated into the intermediate delivery code

Itermediate is all single iso 3D and IMRT
Complex is if using dibh or gating or sgrt or multi isos. SBRT will still be separate but I don't think it was being billed with that anyways

- mole at the RUC
Click to expand...

That sounds like a technical side billing issue then.
77014 had been bundled on the tech side with IMRT for a while now but a 77014-26 professional code has remained.
 
BobbyHeenan said:
That sounds like a technical side billing issue then.
77014 had been bundled on the tech side with IMRT for a while now but a 77014-26 professional code has remained.
Click to expand...
Again, freestanding centers will need some clarification (they can bill 77014-TC with IMRT). Or they may be totally unscathed by any of these CPT changes. Who knows!
 
BobbyHeenan said:
That sounds like a technical side billing issue then.
77014 had been bundled on the tech side with IMRT for a while now but a 77014-26 professional code has remained.
Click to expand...
My question for ASTRO would be (if I was still a member): since 77014 is deleted, is 77387-26 going to finally be valued in the MPFS or are we going to just have to use G6002 for all IGRT (which doesn't seem to fit for CBCT imaging). Either way, I would expect reimbursement to decrease but perhaps not as much if 77387-26 is valued based on weighted use of CBCT and kv imaging in nationwide practice.
 
BobbyHeenan said:
That sounds like a technical side billing issue then.
77014 had been bundled on the tech side with IMRT for a while now but a 77014-26 professional code has remained.
Click to expand...
77014 has absolutely no technical component for a CBCT on a IMRT plan.
It IS bundled into the TC delivery already.

The only reimburseable 77014 is with the modifier (26) on it for professional review.

This is the SAME exact code that is used to CT SIM set up as well. In that situation there is a technical reimbursement.

So my question: Is it deleted or not?
How are they changing it?
Is the CBCT professional review being deleted?
 
firewicket said:
77014 has absolutely no technical component for a CBCT on a IMRT plan.
It IS bundled into the TC delivery already.

The only reimburseable 77014 is with the modifier (26) on it for professional review.

This is the SAME exact code that is used to CT SIM set up as well. In that situation there is a technical reimbursement.

So my question: Is it deleted or not?
How are they changing it?
Is the CBCT professional review being deleted?
Click to expand...

I haven't read Simul's post in great detail, just skimmed it this morning. I talked with some other people about this as well and their take was similar to Simul's from what I gathered so far.

General take away is it's not likely that they just completely remove pro reimbursement for a CBCT....but we will likely see a new code that may or may not just include any form of guidance - be it kv daily orthogonals, surface guidance, and CBCT. And that code will likeyl reimburse less than 77014-26.


radiationeconomics.substack.com

2026 Radiation Oncology Coding and Reimbursement Changes

Breaking down what’s changing
radiationeconomics.substack.com radiationeconomics.substack.com
 
thesauce said:
This is for free-standing as well as HOPP? Is this due to go into affect in 2026?
Click to expand...

Though I'm sure there will be some nuances, what they're talking about in the astro blog (merging Tx delivery codes on tech side; changing image guidance codes) will in one way or another impact both free standing and HOPP.
 
I came across some web links from the recent past talking about how the ACR was advocating for the AMA to make “radiation treatment delivery” code changes for 2026… and that ASTRO was involved:

www.auntminnie.com

ACR advocates for CPT code changes

The ACR and other top U.S. radiology organizations requested CPT code changes at the AMA’s September 2024 CPT Editorial Panel meeting.
www.auntminnie.com www.auntminnie.com

Was ASTRO involved and lobbied for these changes, or did they get totally ignored by the ACR and/or AMA, or what? It’s just vague enough to make me conspiracize.
 
TheWallnerus said:
I came across some web links from the recent past talking about how the ACR was advocating for the AMA to make “radiation treatment delivery” code changes for 2026… and that ASTRO was involved:

www.auntminnie.com

ACR advocates for CPT code changes

The ACR and other top U.S. radiology organizations requested CPT code changes at the AMA’s September 2024 CPT Editorial Panel meeting.
www.auntminnie.com www.auntminnie.com

Was ASTRO involved and lobbied for these changes, or did they get totally ignored by the ACR and/or AMA, or what? It’s just vague enough to make me conspiracize.
Click to expand...

My Overton Window for possibilities of ASTRO involvement/ASTRO F*ing something up on purpose or unintentionally is about the size of an old school small cell hemibody field.
 
It’s incredibly disheartening how much goes on beyond closed doors and how little leadership cares about rank and file folks.

ROCR was hastily presented more due to seeing a window then anticipating immediate large cuts, which is what I was told but could be wrong. But that could be a lie and maybe some in the know had word large cuts were coming.

Dead horse analogy applied, all of this makes the RVU projections from the supply - demand model over optimistic except for maybe the worst case model productivity. Why can’t our leaders at least control the things in our purview and start limiting residency spots if they can’t stop the draconian cuts continuing from CMS?
 
DebtRising said:
It’s incredibly disheartening how much goes on beyond closed doors and how little leadership cares about rank and file folks.

ROCR was hastily presented more due to seeing a window then anticipating immediate large cuts, which is what I was told but could be wrong. But that could be a lie and maybe some in the know had word large cuts were coming.

Dead horse analogy applied, all of this makes the RVU projections from the supply - demand model over optimistic except for maybe the worst case model productivity. Why can’t our leaders at least control the things in our purview and start limiting residency spots if they can’t stop the draconian cuts continuing from CMS?
Click to expand...


As was said 'ASTRO does not comment on work force issues to antitrust concerns'

Hence not their concern. They can't stop the oversupply train. They can't stop the increase in underemployed Rad Oncs who are doing more of the scut and machine coverage and direct supervision coverage requirements than they are Rad Oncs. They can't stop the potential of the unemployed Rad Oncs after 2030.

Of course, The fact that ASTRO leadership (which is near ubiquitiously people who benefit from having a cheaper workforce, such as people in academic leadership or big wigs at large private practices) benefits from having an oversupply and thus being able to pay physician less or give less protected research time or have longer partner tracks is immaterial.

And of course, the fact that those in academic leadership (reportedly 16 of 19 ASTRO leaders) and are able to EXPAND residencies, is immaterial as well.

Nothing to see here.

Nothing To See Here GIF by Giphy QA
 
evilbooyaa said:
As was said 'ASTRO does not comment on work force issues to antitrust concerns'
Click to expand...

If ASTRO was so concerned about antitrust, ASTRO wouldn't have its own proprietary, privately conducted, and privately shared salary survey with SCAROP.

This tells you all you need to know about ASTRO's priorities. Overtraining? No comment. Collusion on salaries? ASTRO leading the way.
 
With EM, it seems like the ACGME bypassed the "anti-trust issue" by arguing that 3 years wasn't enough education (which is much more palatable than 'the job market collapsed because of mid-level providers and VC, so we need to make training take longer').

If there was ANY will to help stave off job market concerns, ASTRO could lobby the ACGME to dramatically increase standards for residencies, making it harder for smaller programs to stay open and/or making it harder for big programs to have as many spots -there would, of course, be a good face-saving argument there as well. Problem is... ASTRO doesn't really have a reason to care, as cheap labor is helpful to the stake-holders. The only way I could see this happening independent of ASTRO is if there was a concerted effort at the ACGME to drive applicants into fields where there are a shortage of docs (like FM, psych, OB/GYN etc...) -this could potentially be an avenue to fewer rad onc residency spots
 
Lamount said:
With EM, it seems like the ACGME bypassed the "anti-trust issue" by arguing that 3 years wasn't enough education (which is much more palatable than 'the job market collapsed because of mid-level providers and VC, so we need to make training take longer').

If there was ANY will to help stave off job market concerns, ASTRO could lobby the ACGME to dramatically increase standards for residencies, making it harder for smaller programs to stay open and/or making it harder for big programs to have as many spots -there would, of course, be a good face-saving argument there as well. Problem is... ASTRO doesn't really have a reason to care, as cheap labor is helpful to the stake-holders. The only way I could see this happening independent of ASTRO is if there was a concerted effort at the ACGME to drive applicants into fields where there are a shortage of docs (like FM, psych, OB/GYN etc...) -this could potentially be an avenue to fewer rad onc residency spots
Click to expand...
Speaking of EM, do you think increasing residency to 6 years would somewhat help the job market?
 
Lamount said:
With EM, it seems like the ACGME bypassed the "anti-trust issue" by arguing that 3 years wasn't enough education (which is much more palatable than 'the job market collapsed because of mid-level providers and VC, so we need to make training take longer').

If there was ANY will to help stave off job market concerns, ASTRO could lobby the ACGME to dramatically increase standards for residencies, making it harder for smaller programs to stay open and/or making it harder for big programs to have as many spots -there would, of course, be a good face-saving argument there as well. Problem is... ASTRO doesn't really have a reason to care, as cheap labor is helpful to the stake-holders. The only way I could see this happening independent of ASTRO is if there was a concerted effort at the ACGME to drive applicants into fields where there are a shortage of docs (like FM, psych, OB/GYN etc...) -this could potentially be an avenue to fewer rad onc residency spots
Click to expand...
ACGME, ASTRO and all the others are membership organizations underwritten by dues paying members. They want more members; growth is fundamental to their survival.
 
Lamount said:
With EM, it seems like the ACGME bypassed the "anti-trust issue" by arguing that 3 years wasn't enough education (which is much more palatable than 'the job market collapsed because of mid-level providers and VC, so we need to make training take longer').

If there was ANY will to help stave off job market concerns, ASTRO could lobby the ACGME to dramatically increase standards for residencies, making it harder for smaller programs to stay open and/or making it harder for big programs to have as many spots -there would, of course, be a good face-saving argument there as well. Problem is... ASTRO doesn't really have a reason to care, as cheap labor is helpful to the stake-holders. The only way I could see this happening independent of ASTRO is if there was a concerted effort at the ACGME to drive applicants into fields where there are a shortage of docs (like FM, psych, OB/GYN etc...) -this could potentially be an avenue to fewer rad onc residency spots
Click to expand...
Didn't Neha Vapiwala / ACGME do some of this with new faculty to resident ratios and new disease site minimums that they estimate would force like 10% downsize of slots?
 
evilbooyaa said:


As was said 'ASTRO does not comment on work force issues to antitrust concerns'

Hence not their concern. They can't stop the oversupply train. They can't stop the increase in underemployed Rad Oncs who are doing more of the scut and machine coverage and direct supervision coverage requirements than they are Rad Oncs. They can't stop the potential of the unemployed Rad Oncs after 2030.

Of course, The fact that ASTRO leadership (which is near ubiquitiously people who benefit from having a cheaper workforce, such as people in academic leadership or big wigs at large private practices) benefits from having an oversupply and thus being able to pay physician less or give less protected research time or have longer partner tracks is immaterial.

And of course, the fact that those in academic leadership (reportedly 16 of 19 ASTRO leaders) and are able to EXPAND residencies, is immaterial as well.

Nothing to see here.

Nothing To See Here GIF by Giphy QA
Click to expand...


I have had many questions, but one that popped front of mind is if he genuinely believes ROCR will reduce administrative burden for practices. It seems like no considering that we will need to double-code cases for CMS tracking. Plus you will now need to do a documentation/accreditation program. That hasn't been discussed in a while.

Also, how are conversations going with CMS? It's been 2.5 years since RO-APM was put on hold.

Maybe these will get answered in the town hall.
 
bops said:
Didn't Neha Vapiwala / ACGME do some of this with new faculty to resident ratios and new disease site minimums that they estimate would force like 10% downsize of slots?
Click to expand...
Yeah. The other thing was forcing a large percentage of activity to be done at the main site so programs couldn't expand based on satellite numbers. But it was effective for class of 2026 if i recall correctly. So will take time to work through the system. Even then 10% cut seems unrealistic, but preventing/minimizing expansion more likely.
 
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temujim said:
Yeah. The other thing was forcing a large percentage of activity to be done at the main site so programs couldn't expand based on satellite numbers. But it was effective for class of 2026 if i recall correctly. So will take time to work through the system. Even then 10% cut seems unrealistic, but preventing/minimizing expansion more likely.
Click to expand...

Too little too late
 
I would also like to call out ASTRO leadership and other academic members of our specialty who are ostensibly liberal and previously highly supportive of DEI for continuing to promote themselves on Elon Musk's platform in this political environment.

This is a bizarre choice when there are neutral platforms like SDN or their heavily moderated ASTRO forum. In addition, forum based platforms are much more suited for longer and more nuanced analyses rather than making the forced repeated tiny posts on X/Twitter.
 
Neuronix said:
I would also like to call out ASTRO leadership and other academic members of our specialty who are ostensibly liberal and previously highly supportive of DEI for continuing to promote themselves on Elon Musk's platform in this political environment.

This is a bizarre choice when there are neutral platforms like SDN or their heavily moderated ASTRO forum. In addition, forum based platforms are much more suited for longer and more nuanced analyses rather than making the forced repeated tiny posts on X/Twitter.
Click to expand...


Bro.
 
Neuronix said:
I would also like to call out ASTRO leadership and other academic members of our specialty who are ostensibly liberal and previously highly supportive of DEI for continuing to promote themselves on Elon Musk's platform in this political environment.

This is a bizarre choice when there are neutral platforms like SDN or their heavily moderated ASTRO forum. In addition, forum based platforms are much more suited for longer and more nuanced analyses rather than making the forced repeated tiny posts on X/Twitter.
Click to expand...
Nice, very nice. But if there is not an audience for their preening then what's the point?
 
Neuronix said:
I would also like to call out ASTRO leadership and other academic members of our specialty who are ostensibly liberal and previously highly supportive of DEI for continuing to promote themselves on Elon Musk's platform in this political environment.

This is a bizarre choice when there are neutral platforms like SDN or their heavily moderated ASTRO forum. In addition, forum based platforms are much more suited for longer and more nuanced analyses rather than making the forced repeated tiny posts on X/Twitter.
Click to expand...

SDN - anonymous, nobody cares, they can hear what people actually think about them (whether it be positive or negative) without reprecussions professionally

ASTRO Forum - lol who actually reads that?

Getting likes/re-tweets is tied to their reward centers. Twitter is an addiction for many, even if the policies of the boss are so antithetical to their daily living. See similarly for Amazon.
 
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