CMS has released the CY 2027 Hospital Outpatient Prospective Payment System (OPPS) Proposed Rule, outlining several important reimbursement updates for hospital-based radiation oncology providers.

Key Highlights

• 2.4% Proposed OPPS Payment Increase: Hospitals that meet quality reporting requirements would receive a proposed 2.4% increase in outpatient payment rates for CY 2027.
• Strong Payment Growth for Radiation Oncology: CMS is proposing double-digit reimbursement increases for many core radiation oncology services, including treatment delivery, SRS/SBRT, proton therapy, treatment planning, and other radiation oncology procedures.
• Treatment Delivery Increases: Proposed reimbursement increases include:
  • CPT 77402: +26%
  • CPT 77407: +17%
  • CPT 77412: +14%
• SRS/SBRT and Proton Therapy: CMS is also proposing meaningful payment increases for stereotactic radiosurgery (SRS), stereotactic body radiation therapy (SBRT), and proton therapy services.
• Site-Neutral Payment Expansion: CMS proposes expanding site-neutral payment policies to include certain imaging services performed in excepted off-campus provider-based departments, with rural sole community hospitals remaining exempt.
• Biology-Guided Radiation Therapy (BgRT): CMS has proposed updated APC assignments and payment rates for BgRT services as additional claims data becomes available.
• 340B Drug Payment Changes: CMS proposes revising reimbursement for 340B-acquired drugs to Average Sales Price (ASP) minus 33.4%, replacing the current ASP +6% methodology. While this could increase reimbursement for many outpatient services, it may reduce payments for 340B-acquired drugs and radiopharmaceuticals commonly used in oncology.
• Therapeutic Radiopharmaceuticals: CMS proposes maintaining the current OPPS payment methodology, with no significant structural payment changes.

Next Steps

The proposed rule is open for public comment before CMS issues the Final Rule later this year. Radiation oncology providers should review these proposals carefully, as several could have meaningful financial and operational implications for hospital outpatient departments.

Fill out the form on this page to download our complete 2027 OPPS Proposed Rule Summary, including detailed reimbursement tables, code-specific payment comparisons, and RBS analysis of the proposed changes, and sign up for our newsletter to get a detailed letter, including a year-to-year comparison of all radiation oncology codes.

Have questions about how these proposals could impact your organization? Radiation Business Solutions is here to help. Contact our team to discuss what these proposed updates mean for your radiation oncology program.