2013 Radiation Oncology Reimbursement Update

In August MD Buyline reported on the proposed cuts to radiation oncology reimbursement for 2013. With cancer treatment facilities anxiously anticipating its release, CMS disclosed on November 1st  the 2013 Medicare Physician Fee Schedule Final Rule which includes a 7% overall cut to radiation oncology and a 9% overall cut to radiation therapy centers. While an improvement compared to the overall 15%-19% originally proposed, this will still have significant effects on radiation oncology providers.

Changes were partially attributed to the last of a 4-year transition to the new Physician Practice Information Survey (PPIS).  Additionally, CPT Codes 77418 (IMRT Treatment Delivery) and 77373 (SBRT Treatment Delivery) were identified as potentially misvalued. While CMS did agree with the addition of a second therapist for IMRT procedures and changes to resource-intensive capital equipment, it was determined that the procedure time for IMRT should be adjusted from 60 minutes down to 30 minutes. SBRT procedure time also decreased from 90 minutes to 60 minutes. All factors taken into consideration, CPT 77418 will suffer a 15% cut in 2013 (compared to the 40% proposed in July) while CPT 77373 decreases by 20% (compared to the 28% originally proposed in July).

In addition to the reasons mentioned above, there were multiple other factors that played into the reductions for 2013. The excerpt below taken from the CMS Final Rule provides a breakdown of the changes for next year.

 RMB blog graph

However, it’s not all bad news for radiation oncology. The Final Rule acknowledged that IORT reimbursement should be separate from surgery charges and created a distinct payment value for the treatment delivery. IORT delivery has been assigned a Level 1 ambulatory payment classification. Additionally, the payment value for IORT more than doubled the originally proposed value in July 2012.

We will also see the addition of a new CPT code for thoracic radiosurgery (32701). This code was created for the thoracic surgeon when performing SRS/SBRT treatments in the thoracic region that are not cranial or spinal related.  Radiation Treatment Management and SBRT Delivery codes will still be reported by the radiation oncologist.

The above mentioned changes take effect January 1, 2013.  For more information on reimbursement changes for 2013, the complete Final Rule can be found on CMS’s website.

Rachael Bennett, BHS, R.T. (R)(T)
ABOUT THIS EXPERT
Rachael Bennett, BHS, R.T. (R)(T), Clinical Analyst — Ms. Bennett joined MD Buyline in 2008 with seven years of clinical experience in the medical field. Ms. Bennett is the primary clinical analyst for linear accelerators, stereotactic radiosurgery, mammography systems, biopsy systems and other radiation oncology and women’s health capital equipment codes. She graduated from Baylor Allied Health School with a major in radiography and went on to specialize in radiation therapy at Washburn University. She currently holds registries as both a radiographer and radiation therapist through the American Registry of Radiologic Technologists (ARRT).