The American Society for Radiation Oncology (ASTRO) has explained what will and will not work about radiation oncology payment policies proposed under the 2026 Medicare Physician Fee Schedule (MPFS).
In a 25-page comment letter to the Centers for Medicare and Medicaid Services (CMS), ASTRO elaborated on three issues: payment policies, payment rates, and quality provisions.
"Specifically, ASTRO supports Medicare’s plan to use hospital outpatient cost data to inform freestanding technical reimbursement for many common radiation therapies but, critically, urges the Agency to use the appropriate hospital data and coding structure to reflect significant changes to key radiation codes starting January 1, 2026," the society said.
ASTRO included several key recommendations, among them related to radiation treatment codes and radiation oncology treatment delivery, the methodology of bundled services, physician work and relative value units (RVUs), and practice expenses. Concerns include multistep rate setting, potential billing confusion and errors, and utilization mapping.
ASTRO pointed out that large radiation oncology practices are growing, while smaller, solo practices are suffering. Failure to make necessary corrections in the final rule could be a death knell in 2026 to community-based radiation oncology practices, according to ASTRO Board Chair Howard Sandler, MD.
Additionally, more work is needed on comprehensive payment reform for radiation oncology.
"We recognize there are many moving parts in this proposed rule (e.g., efficiency adjustment, change in the indirect PE methodology)," ASTRO President Vivek Kavadi, MD, and Sandler stated. "ASTRO encourages the Agency to consider phasing in any significant changes to RVUs for radiation oncology services as a result of implementing this new rate setting methodology (e.g., four-year phase in similar to supplies/equipment/clinical labor changes)."
ASTRO has also urged Congress to pass the bipartisan Radiation Oncology Case Rate (ROCR) Act before the end of the year.
The entire comment letter on the 2026 MPFS can be read here.
