Amar Rewari, Chief of Radiation Oncology at Luminis Health, shared a post on LinkedIn:
“The Real History Behind the New RT Treatment Delivery Codes
One of the biggest changes in this year’s Medicare Physician Fee Schedule is the complete rebuild of our radiation treatment delivery codes. Many have asked how we reached this point, so this first post in a four part series focuses on the history. The only way to understand the final values is to understand the path that got us here.
How the G-codes Started
Most of us have been using the current G-codes for more than a decade. They were never meant to be permanent. In 2014 and 2015, ASTRO worked with CPT and the AMA RUC to modernize treatment delivery and IMRT coding. We created new CPT codes, including a split between simple and complex IMRT and descriptors that reflected the workflow at the time.
Those codes passed CPT and the RUC with full valuations. When they reached CMS, CMS rejected the entire package. Because the old CPT codes had already been deleted, CMS created temporary G-codes for freestanding centers. Hospital outpatient departments continued using the CPT codes that had been approved. For the next decade, our specialty had two different systems for billing the same services.
Why the G-codes Stayed Frozen
When CMMI proposed the Radiation Oncology Model, we needed stability to maintain a valid control group. If the fee schedule shifted mid-model, comparisons would be impossible. So when the RUC pushed us to revalue the G-codes, ASTRO argued for holding them steady. CMS agreed. The G-codes stayed unchanged for years.
Once the RO model was indefinitely paused, the RUC returned to us and made it clear that the misvalued code family had to be addressed with no further delays.
Why We Rebuilt the Codes Instead of Revaluing Them
Rather than revaluing outdated G-codes, ASTRO and ACRO agreed to rebuild the entire delivery family so that it reflected modern practice. I helped lead this effort over the last two years.
A major goal was to eliminate the long-standing prior authorization battles tied to whether a plan was labeled 3D or IMRT. The new codes remove that distinction by making delivery coding planning agnostic. Instead, the focus is on the actual time and resources involved in delivering treatment.
Multiple isocenters take longer. Active motion management takes longer. Mixed electron and photon delivery takes longer. Total skin takes significantly longer. Coding based on time aligns with how the RUC evaluates services, since staff time and resource intensity are central to valuation. This structure reflects the clinical reality that complexity arises from delivery workflow, not from plan labels.
Where We Are Now
CMS has now finalized this fully modernized CPT code family in the 2025 rule. It replaces the fractured dual system we have lived with since 2014 and provides a stable foundation for future technology.”
Proceed to the video attached to the post.
More posts featuring Amar Rewari.