Brian Lally, President of American College of Radiation Oncology, shared a post on LinkedIn:
“The 2027 CMS Proposed Rule: A Significant Shift for Radiation Oncology Technical Payments.
Important policy updates were released by the Centers for Medicare & Medicaid Services (CMS) at the end of the week, signaling a major positive trend for hospital outpatient radiation therapy reimbursements.
To understand this shift, it is helpful to look back at the 2018 340B drug reimbursement adjustments and the subsequent 2022 U.S. Supreme Court ruling. Following extensive drug acquisition cost surveys, CMS is now proposing a budget-neutral policy that would redirect billions of dollars back into non-drug services.
According to the latest update from ASTRO, radiation oncology is expected to be one of the primary beneficiaries of this structural change, with an estimated across-the-board increase of approximately 8.44%.
Key proposed technical payment increases include:
- APC 5621: Up 26%
- APC 5622: Up 17%
- APC 5623: Up 14%
This proposal provides a strong foundation for institutional revenue planning for 2027. It also raises an important question: Could implementing the Radiation Oncology Case Rate (ROCR) model further simplify reimbursement by transitioning the specialty to stable, 90-day bundled payment rates?
Watch the full breakdown for more details, and stay tuned for Part 2, which will explore the implications for freestanding radiation oncology clinics.”
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