CMS Radiation Coding Overhaul Causes Revenue Issues for Many Community Oncology Practices

We are more than 6 months into Medicare’s radiation oncology coding overhaul, and many community radiation oncology practices report negative impacts to their bottom line and the ability to give patients proper treatment.

The Centers for Medicare & Medicaid Services (CMS) projected the January 1 consolidation of treatment delivery codes into 3 complexity tiers (77402, 77407, 77412), with image guidance bundled into a single professional code (77387), would be close to budget neutral at roughly a 1% dip in revenue. But a recent American Society for Radiation Oncology (ASTRO) survey shows that at about 6 months in, more than two-thirds of surveyed physicians reported revenue declines of 10% or greater; many cited 20% to 30%.¹

Half of the survey respondents also said advanced radiation treatments are frequently delayed or denied by insurers, often due to prior authorization requirements or difficulties processing the new billing codes. Physicians reported greater administrative burden as well.1

Ryan Funk, MD, chief radiation oncology officer for The US Oncology Network, told In Practice that while the changes implemented by CMS bring radiation coding into the “modern era,” there’s a challenge with practice and commercial payer contracts due to outdated code definitions.

For example, the technical component of image guidance is bundled, while the professional component is not, leading some payers to deny charges they should not. Once engaged, he said he’s seen payers willing to work toward resolution.

Another risk is consolidation. ASTRO reports reimbursement for radiation therapy has fallen by more than 25% over the past decade, even as the cost of delivering care has increased. Financial pressures have led to rampant consolidation in the field, creating radiation therapy deserts and increasing the distance many patients must travel for treatment.¹

“They’ll either forego treatment or delay treatment until that treatment is less effective,” Dr Funk said, describing, by example, the patients he sees as a radiation oncologist with Minnesota Oncology, who weigh cancer treatment against the tough demands of their livelihoods in farming.

“These findings point to a serious and immediate threat to cancer care in the United States,” Sameer Keole, MD, chair of the ASTRO Board of Directors, said in a press release. “Radiation therapy is a cornerstone of modern cancer treatment and plays a vital role in improving survivorship rates, but these cuts are potentially catastrophic for patient access across the country.”

Dr Funk’s outlook is cautious but not without hope, pointing to CMS’s proposed move toward site-neutral payments as a meaningful lever, alongside continued pressure on commercial payers through ASTRO and American College of Radiation Oncology (ACRO) advocacy.

There are actions community radiation oncologists can take now:

• If you haven’t yet, review payer contracts and engage payers now, document what’s at risk, and communicate consistently with what you need
• Engage with ASTRO and ACRO to support site- neutral payments as CMS evaluates 2027 coding
• Make sure patients understand what their local radiation center provides

“Community radiation oncology practices deliver very high-quality and very convenient patient care, and status quo puts that at risk,” Dr Funk said. “Make sure they understand it’s complex but very important we make that shift.”

Reference

1. American Society for Radiation Oncology. New survey finds Medicare policy changes threaten access to cancer care nationwide. Published April 1, 2026. Accessed August 4, 2026. www.astro.org/news-and-publications/news-and-media-center/news-releases/2026/new-survey-finds-medicare-policy-changes-threaten-access-to-cancer-care-nationwide