On November 1, 2024, CMS published two final rules—the Physician Fee Schedule and the Hospital Outpatient System—introducing several changes relevant to radiation oncology practices, especially those affecting freestanding centers and professional-only billing. Here’s what the final rule means for your practice:
Impact on Radiation Oncology:
The CMS Final Rule introduces reductions in reimbursement rates, presenting financial challenges. Specific cuts include:
- CPT 77290 (Simulation for radiation therapy, complex): Down 4.3%
- IMRT Treatment Delivery: Down 5%
- CT Guidance (77014): Down 3%
- SRS/SBRT Treatment: Down 4.7%
- Respiratory Motion Management (77293): Down 4%
Advocacy Efforts to Limit Cuts:
A bipartisan bill is in progress to stabilize Medicare physician pay for 2025, as highlighted by the American Medical Association.
Physician Supervision:
The CY 2025 Medicare Physician Fee Schedule (MPFS) Final Rule allows for virtual supervision of radiation therapy treatments. This flexibility includes real-time audio and visual interactive telecommunications technology through December 31, 2025.
Radiation Therapy Management (77427):
CMS has provisionally retained Radiation Treatment Management (CPT code 77427) on the Medicare Telehealth Services List following requests to add and remove it permanently.
Biology Guided Radiation Therapy (BgRT):
Effective January 1, 2025, two new G-codes (G0562 and G0563) will replace HCPCS codes C9794 and C9795, expanding payment eligibility for BgRT in settings outside of hospital outpatient departments.
Below you will find summaries of both final rules. We recognize that these changes may pose challenges, but we’re committed to supporting your practice to ensure continued high-quality care for your patients. Please reach out with any questions or for further clarification on these updates.
[pdf-embedder url=”https://radiationbusiness.com/wp-content/uploads/2024/11/Summation-HOPPS-Final-Rule-2025.pdf” title=”Summation HOPPS Final Rule 2025″]
[pdf-embedder url=”https://radiationbusiness.com/wp-content/uploads/2024/11/Summation-CY-2025-MPFS-Final-Rule.pdf” title=”Summation CY 2025 MPFS Final Rule”]
