ASTRO proposes payment reform plan for radiation oncology

The American Society for Radiation Oncology (ASTRO) said it will recommend significant changes to radiation therapy procedure reimbursement codes at the next American Medical Association CPT Editorial Panel meeting in May.

ASTRO said its proposal will address the U.S. Centers for Medicare and Medicaid Services' (CMS) concerns about numerous radiation therapy codes that CMS had identified for review in the 2013 Medicare Physician Fee Schedule Final Rule. Revisions to the radiation oncology CPT code set are a primary component of its payment reform action plan to promote better quality, efficiency, and coordination of care and to achieve optimal patient outcomes, the society said.

Proposed changes include revisions to intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT) that would more appropriately reflect current clinical practices and new technology being utilized, according to ASTRO. It would also package some services together that are typically billed at the same time. The new treatment codes would include code descriptors to better demonstrate the degree of complexity for the treatments, the society said.

January 1, 2015, would be the earliest date any changes could become effective.

ASTRO also announced that it has implemented a new practice accreditation program that could serve as a link to quality for Medicare payment in radiation oncology. It is also launching a data registry that is currently in a pilot testing phase to measure practice performance based on quality measures.

Additionally, the organization has begun an initiative to develop alternatives to the traditional fee-for-service reimbursement model. ASTRO said it plans to identify areas where better coordinated care would improve quality and eliminate unnecessary treatments.

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