On Thursday, July 13, 2023, the Centers for Medicare and Medicaid Services (CMS) released the 2024 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (HOPPS) proposed rules.

Takeaways for Radiation Oncology

• MPFS
  • MPFS Proposed Rule Cuts Radiation Oncology by -2%, largely stemming from the third year of cuts under the clinical labor pricing update policy.
  • 2024 Proposed Conversion Factor: $32.7476 (a reduction of more than 3% from 2023)
  • Although the “G” codes for conventional treatment delivery, IMRT, and IGRT were flagged in the 2023 MPFS final rule for possible revaluation, the 2024 proposed rule does not mention the G codes.
• HOPPS
  • CMS proposes increasing the payment rates under the OPPS by an Outpatient Department (OPD) fee schedule increase factor of 2.8%.
  • The Agency proposes to align HOPPS payment provisions regarding dental services with the 2023 MPFS final rule.
  • CMS seeks to expand the Comprehensive Ambulatory Payment Classification (C-APC) methodology with two new revisions. While neither proposed revision directly impacts radiation oncology services, these proposals indicate that the Agency is still refining the C-APC methodology as it relates to certain services.

Why it matters: The proposed MPFS cuts, in combination with year-over-year reductions, jeopardize access to care for cancer patients. This underscores the need for ASTRO’s proposed Radiation Oncology Case Rate (ROCR) Program, which would secure stable payment rates and protect access to care. ASTRO will continue its advocacy efforts to achieve more appropriate rate updates that recognize the important role that radiation oncology plays in cancer treatment. Radiation oncologists are encouraged to contact Congress to advance legislation to help mitigate the proposed clinical labor cuts.

Go deeper on the MPFS and HOPPS with ASTRO’s detailed summaries.