MPFS 2026 Final Rule 

The 2026 MPFS final rule saw very little change from the proposed rule for radiation oncology. CMS will implement the use of Outpatient Prospective Payment System (OPPS) data to weight the Practice Expense (PE) Relative Value Units (RVUs) for several radiation oncology code families.  

Key highlights include: 

• Code Modernization: CMS will delete 17 HCPCS codes and adopt the revised CPT codes for radiation treatment delivery and image guidance. 

• Superficial Radiation Therapy: CMS will utilize the new CPT codes for superficial treatment, orthovoltage treatment, and electronic brachytherapy. 

• Proton Beam Therapy: CMS will consider a national payment rate in future rulemaking. 

• Physician Supervision via Telehealth: Direct supervision will now be allowed via real-time video communication permanently via a definition change. CPT code 77427 is a permanent item on the telehealth list (requires video).

• Efficiency Adjustments to work RVUs: CMS has finalized an efficiency adjustment of -2.5% to work RVUs and the corresponding intra-service portion of physician time for non-time-based services. 

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