Radiation Therapy Freeze Extended  as of 7-29-19

On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released the CY 2020 Physician Fee Schedule.  In the proposed rule, CMS states the following:

Following the publication of the CY 2015 PFS final rule, the Patient Access and Medicare Protection Act (Pub. L. 114-115, December 28, 2015) was enacted, which included the provision that the code definitions, the work relative value units and the direct inputs for the PE RVUs for radiation treatment delivery and related imaging services (identified in 2016 by HCPCS G-codes G6001 through G6015) for the fee schedule established under this subsection for services furnished in 2017 and 2018 shall be the same as such definitions, units, and inputs for such services for the fee schedule established for services furnished in 2016. In CY 2018, Congress extended this “freeze” in coding descriptions and inputs through CY 2019 as a provision of the Bipartisan Budget Act of 2018. For CY 2020, in the interest of payment stability, we are proposing to continue using these G-codes, as well as their current work RVUs and direct PE inputs.

We are grateful that CMS has listened to ACRO’s concerns regarding payment stability in the Physician Fee Schedule, particularly given the recent release of the proposed radiation therapy APM.

We will continue to review the regulation and provide further updates as warranted.

To review the regulation, please click on this link

For any questions about this announcement, please contact
Jason McKitrick, ACRO government relations staff: jmckitrick@libertypartnersgroup.com

Radiation Therapy APM Released – July 10, 2019

On July 10, 2019, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule entitled, “Medicare Program; Specialty Care Models to Improve Quality of Care and Reduce Expenditures.”  Within that draft regulation, CMS proposes a new alternative payment model (APM) for radiation oncology providers.  We are grateful that CMS has listened to several of ACRO’s concerns relating the model, including:

  • The implementation of a prospective case rate model (rather than a retrospective model);
  • Adequate reimbursement in the form of site-neutral reimbursement based on the OPPS;
  • Coverage of most forms of cancer and modalities; and
  • 90-day episodes of care.

We will continue to review the regulation, in particular with respect to interactions it may have with the upcoming 2020 Physician Fee Schedule and Hospital Outpatient PPS Proposed Rules, as well as the “freeze” contained in the Patient Access and Medicare Protection Act (PAMPA) and Bipartisan Budget Act of 2018.

To review the regulation, please click on this link:
https://s3.amazonaws.com/public-inspection.federalregister.gov/2019-14902.pdf

A fact sheet is available here:
https://www.cms.gov/newsroom/fact-sheets/proposed-radiation-oncology-ro-model