Q&A: Payments for new radiation oncology model

Q: How will CMS make payments for radiation therapy (RT) services under the Radiation Oncology Model rule?

A: Payments will be made for RT services furnished in 90-day episodes for each of the 16 cancer types. The episode payments are divided into separate professional component (PC) and technical component (TC) payments. Half of each payment is paid upon initiation of the episode, which is based on the PC being billed to signify the planning has been completed. The remainder of each payment is made upon completion of the episode, which occurs upon completion of the delivery of the radiation. After an episode ends, if the patient needs any radiation therapy services, those services are excluded from the model for 28 days. If the patient needs radiation therapy services after 28 days from the end of the last episode, another episode would begin. Also, an episode is not complete if the radiation delivery or TC is not started within 28 days of the PC episode initiation.

For more information see, "Note from the instructor: CMS finalizes mandatory radiation oncology model" by Valerie A. Rinkle, MPA, CHRI