A combination of new codes and a revision of practice expense (PE) valuation across all medical specialties looks likely to cut Medicare reimbursement to radiation oncologists by around 40% in 2026, according to experts at the American Society for Radiation Oncology (ASTRO). Parallel cuts from commercial insurers would likely follow.
Cuts May Lead to Further Consolidation, Reduced Access
“Freestanding radiation oncology practices, which are reimbursed under the [Medicare physician fee schedule (MPFS)], could face devastating cuts,” Christopher Jahraus, MD, a radiation oncologist and CEO of Generations Radiotherapy & Oncology in Alabaster, Alabama, told Oncology News Central.
The cuts are also related to hypofractionation, in which higher radiation doses are spread across fewer treatments, said Amar Rewari, MD, chief of radiation oncology with Luminis Health in Annapolis, Maryland. Recent published data have shown that hypofractionation is safe and effective, and thus the number of treatments for which radiation oncology providers bill has declined.