On Wednesday, July 10, 2024, the Centers for Medicare and Medicaid Services (CMS) issued the 2025 Medicare Physician Fee Schedule (MPFS) proposed rule. No additional direct payment cuts to radiation therapy physician services were proposed, but existing policies will continue to depress payments. The proposed rule updates the payment policies, payment rates and quality provisions for services furnished under the MPFS effective January 1, 2025.

Takeaways for Radiation Oncology

• MPFS Proposed Rule estimated impact on radiation oncology: 0%
• 2025 Proposed Conversion Factor: $32.3562 (a reduction of almost 3% from 2024)
• CMS plans to end radiation weekly treatment management telehealth while maintaining virtual direct supervision flexibilities through the end 2025

Why it matters: In aggregate, CMS estimates flat payments for radiation oncology in 2025, but the clinical labor cuts and 2.8% proposed conversion factor reduction will cause many key codes to drop. ASTRO remains very concerned by the 23% decline in radiation oncology payments since 2011 and significant payment threats in future years, and we urge Congress to pass the bipartisan Radiation Oncology Case Rate (ROCR) Act to secure long-term stable payments and enhanced quality. CMS also said it plans to remove from the telehealth list CPT Code 77427, Radiation weekly treatment management, agreeing with ASTRO’s recommendation.

Read ASTRO's MPFS Summary for more detailed information.

Hospital Outpatient Prospective Payment System

Also on July 10, CMS released the 2025 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, which included modest payment increases for radiation therapy services effective January 1, 2025. Like under the MPFS proposed rule, CMS proposes to extend the availability of virtual direct supervision of therapeutic and diagnostic services through the end of 2025.

Read ASTRO's HOPPS Summary for more detailed information.

Comments in response to both proposed rules are due to CMS by September 9, 2024.