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09/25/2020

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.

For additional information, please review CMS Fact Sheet  and the Radiation Oncology Model web page.

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