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This is from physician group in facebook. Looks like freestanding practices are getting hit hard with the new codes.
Here’s Sameer Keole response:
“As the immediate past president of ASTRO and current Chair of the Board, I can confirm that yes, there has been a decline in radiation oncology reimbursement following the recent changes.
CMS initially estimated the impact would be modest — roughly 1% in freestanding centers and about 2% in hospital settings. However, the real-world experience reported by practices across the country suggests the reductions have often been significantly greater. This is due to multiple factors, and it is more complex than can be fully addressed in a single thread.
Since December, ASTRO has been actively engaged with payers, Medicare Administrative Contractors (MACs), and utilization management companies to address implementation issues. As a result of these efforts, we have already seen several policy clarifications and corrections, and additional updates are expected.
We also maintain an active working group of freestanding centers that meets regularly to share real-time experiences and coordinate advocacy efforts. I recently wrote a more detailed column on this topic for ASTRO News, which will be published shortly.
A final point of context: this recent code reevaluation was long anticipated. Radiation oncology, in the MPFS, had been operating under G-codes for more than a decade, even though such temporary codes typically remain in place only 3–5 years. ASTRO successfully advocated for an extension of these G-codes in 2019 due to the ongoing work surrounding the Radiation Oncology Alternative Payment Model. Once that effort was permanently shelved, the AMA asked ASTRO to begin work on a new code submission — a process I outline in more detail in my upcoming Chair’s column.
Looking ahead, we believe the best path to long-term stability for our field — particularly for freestanding centers — is passage of the Radiation Oncology Case Rate (ROCR) model. Our advocacy has already yielded some early wins, most notably ensuring that future updates will be informed by hospital APC (which are based on charge-to-cost ratios). Unfortunately, it will take several years before those benefits are fully realized. Still, this represents a truly historic — and likely unprecedented — development in physician payment policy.
Ultimately, we believe the long-term solution is moving away from fee-for-service and toward a case-rate payment model. In the past decade, Technical reimbursement in the freestanding setting, per case, is down over 30%. It is down roughly 15% in the hospital setting. This is because freestanding settings are affected by both consistent annual decreases in per fraction reimbursement as well as hypo fractionation. Hospital settings typically experience annual bumps in reimbursement per fraction. They still take an overall cut per case based on hypofractionation trends. Professional reimbursement, per case, is down 25% over the same time, regardless of site of setting. To state the obvious, none of this is sustainable. 
In the meantime, if you are encountering specific examples of concerning or unacceptable payer behavior, please reach out to ASTRO directly. We are tracking these cases closely and have already been able to intervene successfully on behalf of our members.”
Here’s Sameer Keole response:
“As the immediate past president of ASTRO and current Chair of the Board, I can confirm that yes, there has been a decline in radiation oncology reimbursement following the recent changes.
CMS initially estimated the impact would be modest — roughly 1% in freestanding centers and about 2% in hospital settings. However, the real-world experience reported by practices across the country suggests the reductions have often been significantly greater. This is due to multiple factors, and it is more complex than can be fully addressed in a single thread.
Since December, ASTRO has been actively engaged with payers, Medicare Administrative Contractors (MACs), and utilization management companies to address implementation issues. As a result of these efforts, we have already seen several policy clarifications and corrections, and additional updates are expected.
We also maintain an active working group of freestanding centers that meets regularly to share real-time experiences and coordinate advocacy efforts. I recently wrote a more detailed column on this topic for ASTRO News, which will be published shortly.
A final point of context: this recent code reevaluation was long anticipated. Radiation oncology, in the MPFS, had been operating under G-codes for more than a decade, even though such temporary codes typically remain in place only 3–5 years. ASTRO successfully advocated for an extension of these G-codes in 2019 due to the ongoing work surrounding the Radiation Oncology Alternative Payment Model. Once that effort was permanently shelved, the AMA asked ASTRO to begin work on a new code submission — a process I outline in more detail in my upcoming Chair’s column.
Looking ahead, we believe the best path to long-term stability for our field — particularly for freestanding centers — is passage of the Radiation Oncology Case Rate (ROCR) model. Our advocacy has already yielded some early wins, most notably ensuring that future updates will be informed by hospital APC (which are based on charge-to-cost ratios). Unfortunately, it will take several years before those benefits are fully realized. Still, this represents a truly historic — and likely unprecedented — development in physician payment policy.
Ultimately, we believe the long-term solution is moving away from fee-for-service and toward a case-rate payment model. In the past decade, Technical reimbursement in the freestanding setting, per case, is down over 30%. It is down roughly 15% in the hospital setting. This is because freestanding settings are affected by both consistent annual decreases in per fraction reimbursement as well as hypo fractionation. Hospital settings typically experience annual bumps in reimbursement per fraction. They still take an overall cut per case based on hypofractionation trends. Professional reimbursement, per case, is down 25% over the same time, regardless of site of setting. To state the obvious, none of this is sustainable. 
In the meantime, if you are encountering specific examples of concerning or unacceptable payer behavior, please reach out to ASTRO directly. We are tracking these cases closely and have already been able to intervene successfully on behalf of our members.”
