Rad Onc Twitter

[alwaysbeIMRTing]

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They will do it again. The obsession from a minority of academic rad oncs over eliminating the correlation between practice revenue and fractions, physician ownership of LINACs, and general supervision will never die and every failure to control the rest of us just pisses them off and emboldens them more. Yeah. Medicare cuts suck. We all agree on that. But this was a lame lie using that to try and sell the above bigger picture to uninformed community docs. The single biggest thing ASTRO can do right now if it cares about the rest of us is protect the payments from 77014 ensuring that the new PC of the treatment code accounting for cbct review is not less on the fee schedule than it was for 77014 (or worst case, zero). Fixed case rates in some settings only are not the way to do that.

 

[HolySmokes]

They will do it again. The obsession from a minority of academic rad oncs over eliminating the correlation between practice revenue and fractions, physician ownership of LINACs, and general supervision will never die and every failure to control the rest of us just pisses them off and emboldens them more. Yeah. Medicare cuts suck. We all agree on that. But this was a lame lie using that to try and sell the above bigger picture to uninformed community docs. The single biggest thing ASTRO can do right now if it cares about the rest of us is protect the payments from 77014 ensuring that the new PC of the treatment code accounting for cbct review is not less on the fee schedule than it was for 77014 (or worst case, zero). Fixed case rates in some settings only are not the way to do that.

Speaking of which, I know this came up in a thread a few months ago and Simul had a good blog post about it, but does anyone know when/where the new fee schedule is released with the new code(s) for image guidance and wRVU amounts?

 

[BobbyHeenan]

Speaking of which, I know this came up in a thread a few months ago and Simul had a good blog post about it, but does anyone know when/where the new fee schedule is released with the new code(s) for image guidance and wRVU amounts?

I don't think the wRVU or reimbursement for the code has been announced yet but would like to see it as well if someone knows.

From people I talk to, it sounds like there *may* be bundling of things like CBCT, surface guidance, orthogal X-rays...all of which had their own codes into one catch-all image-guidance code.....which will *you guessed it* pay less than a CBCT. How much less TBD.

 

[alwaysbeIMRTing]

I would also love to know the rationale behind and just how the AMA came to suddenly decide to "delete" 77014. How exactly did this happen?

 

[BobbyHeenan]

I would also love to know the rationale behind and just how the AMA came to suddenly decide to "delete" 77014. How exactly did this happen?

YES!

I presume you meant CMS....but I don't know how they decide to just cut and bundle. Very opaque process but surely if ASTRO or our "leaders" are involved in shaping this there is much to be concerned about.

 

[alwaysbeIMRTing]

The AMA somehow has a monopoly in establishing CPT(®) codes. It's a total racket.

Accepted revision of codes 77402, 77407, 77412 77412 to consolidate and more clearly specify services provided for radiation treatment delivery; deletion of codes 77014, 77385, 77386; revision, deletion, and addition of introductory guidelines to better define, explain, and differentiate the levels for radiation treatment delivery services; addition of definitions within the guidelines; and revision of the existing Radiation Management and Treatment Table in the Radiology section to accommodate the new codes

https://www.ama-assn.org/system/files/sept-2024-summary-of-panel-actions.pdf

 

[Ray D. Ayshun]

YES!

I presume you meant CMS....but I don't know how they decide to just cut and bundle. Very opaque process but surely if ASTRO or our "leaders" are involved in shaping this there is much to be concerned about.

Can we have a separate thread on what people know about how this will go down. It's already bundled in free-standing right? We're just gonna use a different code with about a 50-60% cut? Like 77014 will become g6002, a different new code, or just nothing?

 

[BobbyHeenan]

Can we have a separate thread on what people know about how this will go down. It's already bundled in free-standing right? We're just gonna use a different code with about a 50-60% cut? Like 77014 will become g6002, a different new code, or just nothing?

That may be helpful.

I only know about hospital based pro fee billing...not sure about free standing.

We've had some chatter here but I can't believe more people on twitter or in publications aren't screaming to high heavens regarding this change...it is a HUGE chunk of our revenue.

 

[Ray D. Ayshun]

The AMA somehow has a monopoly in establishing CPT(®) codes. It's a total racket.

Accepted revision of codes 77402, 77407, 77412 77412 to consolidate and more clearly specify services provided for radiation treatment delivery; deletion of codes 77014, 77385, 77386; revision, deletion, and addition of introductory guidelines to better define, explain, and differentiate the levels for radiation treatment delivery services; addition of definitions within the guidelines; and revision of the existing Radiation Management and Treatment Table in the Radiology section to accommodate the new codes

https://www.ama-assn.org/system/files/sept-2024-summary-of-panel-actions.pdf

I don't really understand how this is valid. 5 of the 6 codes are tech only, while 77014 is prof only.

 

[alwaysbeIMRTing]

I don't really understand how this is valid. 5 of the 6 codes are tech only, while 77014 is prof only.

It's a mystery. Why would the AMA decide to get rid of this code? How did this come up? How do we bill for CBCT review now? They have a monopoly in setting codes.
I suspect ASTRO ROCR shenanigans.

 

[Gfunk6]

 

[Ray D. Ayshun]

It's a mystery. Why would the AMA decide to get rid of this code? How did this come up? How do we bill for CBCT review now? They have a monopoly in setting codes.
I suspect ASTRO ROCR shenanigans.

But including it in that sentence is basically saying we're eliminating imaging review in order to replace it with treatment delivery. It's more like a typo that probably harkens back to the fact that nobody ever decided to clarify the confusion about billing 77014 at sim vs treatment.

 

[alwaysbeIMRTing]

But including it in that sentence is basically saying we're eliminating imaging review in order to replace it with treatment delivery. It's more like a typo that probably harkens back to the fact that nobody ever decided to clarify the confusion about billing 77014 at sim vs treatment.

The description of the code has never made sense for how it is billed post-2014 CT guidance for placement of radiation fields. That's not what I'm doing at the end of treatment every day. 77014 -26 pays $43. Just increase 77427 by $43 x5 since what we're really doing is management. What's the plan? Somebody knows something.

 

[TheWallnerus]

I don't really understand how this is valid. 5 of the 6 codes are tech only, while 77014 is prof only.*

*not in freestanding

 

[TheWallnerus]

Heads up! (Take them out of your a$$es first)

 

[Fpg1245]

The description of the code has never made sense for how it is billed post-2014 CT guidance for placement of radiation fields. That's not what I'm doing at the end of treatment every day. 77014 -26 pays $43. Just increase 77427 by $43 x5 since what we're really doing is management. What's the plan? Somebody knows something.

So are they just deleting codes now to force support for case rates?

 

[TheWallnerus]

So are they just deleting codes now to force support for case rates?

Ooh. Actually that’d be a good idea by them, that is if you hate your nose and want it eliminated from your face.

 

[medgator]

So are they just deleting codes now to force support for case rates?

It's been happening for years. Special physics? Separate Cbct technical charges in the hospital? Separate vsim charges etc