CMS Finalizes Radiation Oncology Model
On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) finalized the Radiation Oncology (RO) model, a mandatory payment model that requires participation from radiotherapy (RT) providers and suppliers that furnish RT services within randomly selected core-based statistical areas (CBSAs)—which are linked to ZIP Codes. A Participating ZIP Code list includes all the ZIP Codes linked to the CBSAs selected for participation in the RO Model. The selected CBSAs contain approximately 30% of all eligible Medicare fee-for-service (FFS) radiotherapy episodes nationwide.
RO participants treating beneficiaries with one of the 16 included cancer types will receive prospective, site neutral, modality agnostic, episode-based payments for included RT services furnished during a 90-day episode of care, instead of regular Medicare FFS payments. This change will last the entire model performance period, which will run from January 1, 2021 to December 31, 2025.