As organizations transition to the new treatment delivery codes, it’s important not to assume your contracted rates have kept pace.

We’re already seeing situations where contracts still reference outdated code sets or legacy values — creating potential misalignment between actual costs, expected reimbursement, and payer readiness.

Here are a few key considerations when reviewing or renegotiating your payer contracts:

• Confirm fee schedule updates:
  Many payers have not yet incorporated the new CPT code sets into their reimbursement structure. Validate whether they are paying the new codes correctly — and if not, initiate an amendment request.
• Revenue neutrality (at minimum):
  Ensure that the shift to the new code family does not reduce reimbursement relative to historical performance. This is especially critical when codes have been consolidated or re‑valued.
• New services or technology added since your last contract:
  If you’ve expanded modalities, added technology, or enhanced capabilities since your original agreement, make sure your contract reflects that new value.
• Access to Care:
  Proximity to the nearest alternative cancer treatment center is a key factor in contract negotiations. Contract terms should reflect that access dependency.
• Longevity/Impact to Community:
  Providers that have a longstanding operational history and an established presence in the community should seek contract terms that reflect the providers’ value added to the community.  
• Operational and documentation changes:
  Updated coding rules often require changes in workflow, documentation, and authorization processes. Contracts should account for additional administrative burden or resource needs.
• Payer readiness varies:
  As noted in recent industry reviews, some payers are ready to process the new sets, while others continue to use outdated logic or crosswalks. Identifying payer‑specific gaps early can prevent downstream claim issues.

Bottom line: As the industry adopts the revised/new CPT structure, proactively reviewing your payer agreements is essential. Don’t wait until denied claims or unexpected underpayments force the conversation. Use this transition period to ensure your organization is protected, appropriately reimbursed, and aligned with current coding standards.