Recent billing code changes wreaking havoc for radiation oncologists, new survey finds
Recent billing code changes are wreaking havoc for radiation oncologists, according to new survey data shared Wednesday.
The overhaul first took effect on Jan. 1, with most radiation therapy now divided into 3 different levels ranging from “simple” to “complex.” These changes included deleting code 77014 for CT guidance of RT and the addition of a separate code for the professional component of such imaging use.
Less than three months into 2026, and physicians are reporting myriad challenges with the changes, the American Society for Radiation Oncology reports. Federal officials had claimed the updates would only reduce payments to the specialty by about 1%. However, over two-thirds of those surveyed reported payment declines of 10% or greater, with some saying reductions have reached upward of 30%.
“These findings point to a serious and immediate threat to cancer care in the United States,” Sameer Keole, MD, chair of ASTRO’s Board of Directors, said in a statement April 1. “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.”
ASTRO administered the survey over the course of two weeks in March, reaching a total of 160 radiation oncologists. Respondents reported “widespread financial strain,” spanning both freestanding and hospital-based practices. Those working in independent, community-based clinics appear to be bearing the brunt, the survey found.
“This is a financial emergency for our practice,” one physician said in the free-text portion of the survey. “We have let one physician go because we cannot afford to pay them. We are struggling to make payroll for the few number of employees we have on staff.”
Among those surveyed, about 76% said the new radiation therapy treatment codes had a “significant negative impact” on January collectables for their facility-based practice. About 68% in other nonfacility settings said the same. Meanwhile, about 50% of those surveyed said they’ve seen a significant negative impact on their payroll since the changes went into effect.
New Level 3 codes (77412) are meant to report the delivery of “complex” radiation therapy. However, about 53% of respondents reported problems with payers frequently downcoding or denying payment in these circumstances. “Payer interpretation of code definitions” was the most common reasons for Level 3 delivery challenges, reported by 92% of respondents. Others attributed denials to documentation requirements (39%), billing/vendor guidance (28%) or internal coding uncertainty (26%).
“It feels like insurance companies are trying to drown us in paperwork to avoid paying for the standard of care,” one respondent wrote.
Radiation oncologists estimated that most RT delivery cases are coded as Level 2 (intermediate), at an average of about 64%, more than was previously estimated by Medicare. About 26% of cases are complex Level 3, while the smallest portion are Level 1 (12%). ASTRO noted that these proportions were similar across both hospital and freestanding settings.
“Most insurance providers are actively delaying payments. Insurers are making an uphill battle for approval of any Level 3 treatment,” another respondent said.
More on the changes
ASTRO previously offered details about the coding changes in its society news publication. The updates trace to 2024, when the American Medical Association’s CPT Editorial Panel approved “significant” modifications to RT treatment delivery and image guidance codes.
These modifications were meant to reflect advances in technology and care delivery, dramatically impacting how radiation oncology services are valued by Medicare. The new codes received widespread praise in the industry. However, a big part of the current problem rests in CMS undervaluing the codes, Oncology News Central reported in March.
“I know of no circumstance in which a code revision or code revaluation has ever resulted in improved pay for physicians,” Christopher Jahraus, MD, a radiation oncologist involved in the new codes’ development, told the news outlet. “I practice in a freestanding center, and while CMS did some things with the code valuation that are fundamentally very good, we still took a very serious hit to our reimbursement.”
These challenges come on top of the long-term trend of undervaluing radiation therapy services at the federal level, ASTRO noted Wednesday. Reimbursement for RT has fallen by more than 25% over the past decade, at a time when the cost of delivering care has climbed. Financial pressures have led to “rampant consolidation” in the specialty, ASTRO said, and created RT deserts that make care delivery more challenging.
“What we are seeing now is the tipping point,” ASTRO Chair Dr. Keole said in the announcement. “Years of cuts, combined with these new changes, are pushing many practices to the brink. Without intervention, clinic closures and consolidation will accelerate, further limiting access to cancer care.”
The society is calling for “urgent, targeted action” to help address this issue. Possible policy remedies would include passage of the recently introduced Provider Reimbursement Stability Act of 2026, which would cap Medicare cuts under the physician fee schedule. ASTRO also is pushing for passage of the Radiation Oncology Case Rate (ROCR) Value Based Payment Program Act of 2025. Proposed a year ago, the bill seeks to realign the RO specialty, so Medicare pays for the quality of care, rather than the number of times patients visit cancer clinics.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.