HAP Radiology Billing and Coding Blog

There are relatively few CPT1 coding changes for radiation oncology treatments in store for 2016, at least when compared with diagnostic and interventional radiology. CMS, the Centers for Medicare and Medicaid Services, is still considering and revising a new set of codes for radiation treatment delivery that was proposed in 2015 but not yet implemented. When implementation does occur, these codes will most likely not involve valuation differences, although this in an uncertainty until CMS takes action in some future year.

The stage is set for an interesting year of coding, billing and reimbursement in radiation oncology. The CPT1 coding structure for radiation oncology services underwent significant revision in order to bundle certain services that are usually reported together and to clarify the meaning of some codes in the context of current clinical practice. In some cases this required the creation of new CPT codes to describe these services, or revision of the descriptions of existing codes in other cases. Medicare’s decision not to fully recognize these coding changes creates the potential for two different systems to be in place for 2015, and is sure to cause discrepancies between billing for Medicare and billing for other payers.

The Medicare Physician Fee Schedule (MPFS) for 2015 sets the allowed fees for radiation therapy centers at a 1% increase, while radiation oncology professional services will remain unchanged. The Centers for Medicare and Medicaid Services (CMS) had originally proposed drastic cuts in both the professional and technical components but instead elected to defer any decision on assumptions related to major practice expense categories while additional data is gathered.