ACRO Call to Action: Updates from the Proposed Rules

Dear ACRO Members: 

ACRO Advocacy efforts are clearly demonstrated in the 2026 Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Proposed Rules released earlier this week. Our work relating to a new radiation therapy code set and a site-neutral radiation therapy episode-based payment model are reflected in these regulations. CMS is proposing (1) to adopt the treatment delivery code set ACRO developed collaboratively with ASTRO (see appendix) and (2) a site-neutral payment mechanism for the new treatment delivery codes. 

However, ACRO would like to call attention to a possible catastrophic concern  in the rules: the placement of key radiation therapy delivery codes (77407 – radiation treatment delivery, intermediate; 77412 – radiation treatment delivery, complex) in inappropriate ambulatory payment classification (APC) groups under the OPPS rule. This error would negatively impact payments in the hospital outpatient setting and, due to the proposed site-neutral payment mechanism, will carry over to the PFS as well for potentially harmful effects in both settings. 

ACRO believes there are clear cost and clinical rationale for CMS to move these codes to more appropriate APCs. We urge you to help ACRO advocacy by weighing in directly with CMS to correct this error. In the coming weeks, please be on the lookout for a new grassroots platform that ACRO will be implementing to allow ACRO Members to contact CMS directly on this issue. 

In addition, ACRO Members can continue to help advance legislation to provide permanent stability to radiation oncology through legislative options such as the bipartisan Radiation Oncology Case Rate (ROCR) Act (S. 1031/HR. 2120). You can contact your Member of Congress to support ROCR by clicking here. 

ACRO will provide comments to CMS on these regulations later this summer and continue to keep its membership informed on these issues. 

To review the PFS rule, click here. To review the OPPS rule, click here.

A more detailed summary of the regulations follows and you can also visit acro.org for additional news. Our health policy team will be featuring a podcast to discuss these updates further in the near future.

KEY PROVISIONS IN THE 2026 PFS AND OPPS PROPOSED RULES  

This week, the Centers for Medicare & Medicaid Services (CMS) released the 2026 Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) Proposed Rules. A topline summary of provisions in the regulations is included below. 

2026 PFS Proposed Rule. Key policies included in the PFS rule include: 

• Conversion Factor
• The rule includes a 3.32% update to the PFS conversion factor for 2026 for non-APM providers. 
• Use of OPPS APCs to establish payment for Radiation Oncology Treatment Delivery, Superficial Radiation Treatment, and Proton Beam Treatment Delivery 
• CMS: “We are proposing to utilize the relationship between the proposed OPPS APC relative weights for APCs 5621, 5622, and 5623 to inform the valuation of PE-only CPT codes 77402, 77407, and 77412 when paid under the PFS.”
• CMS explicitly acknowledges the work done by ACRO and ASTRO with CMS and CMMI on an “episode-based alternative payment approach for radiation therapy services.” However, in pursuing this policy, ACRO believes CMS has inappropriately placed 77407 and 77412 in Ambulatory Payment Classification (APC) 5622 “Level 2 Radiation Therapy” in the OPPS Proposed Rule, which, by virtue of the new policy has negative carry-over effects to the PFS Proposed Rule. Based on cost and clinical data, ACRO will be advocating for the more appropriate placement of (1) 77407 in APC 5623 and (2) 77412 in APC 5624. 
• Updates to the Indirect Practice Expense (PE) Methodology 
• CMS: “We are proposing to reduce the portion of the facility PE RVUs allocated based on work RVUs to half the amount allocated to non-facility PE RVUs beginning in CY 2026.”
• As it relates to non-treatment delivery codes, this policy, in conjunction with the conversion factor update, results in the first generally positive update for freestanding radiation oncology providers in the last several years. 
• No Use of AMA Physician Practice Information Survey (PPIS) Data
• CMS: “Due to overarching concerns with the data … and our previously described policy goal to balance PFS payment stability and predictability with incorporating new data through routine updates to the MEI, we reiterate that we are not proposing to implement the PE/HR data or cost shares from the AMA’s survey data at this time, and are proposing instead to maintain the current PE/HR data and cost shares for CY 2026 PFS ratesetting.”
• ACRO-commissioned analyses found that the use of AMA PPIS data would have resulted in cuts of 18% or more for key treatment delivery codes. 
• Maintenance of 77427, Radiation tx management 5x, on the Telehealth List
• CMS proposes maintaining 77427 on the telehealth list for 2026. 
• As ACRO noted in its comment to the 2025 PFS Proposed Rule, face-to-face engagement between radiation oncologists, clinical treatment teams, and patients undergoing treatment is the most appropriate way to manage care. ACRO continues to believe that the use of telehealth for the face-to-face portion of radiation treatment management is no longer necessary now that the COVID-19 Public Health Emergency has concluded.

2026 OPPS Proposed Rule. Key policies included in the OPPS rule include: 

• Conversion Factor
• The rule includes a 2.4% update to the OPPS conversion factor for 2026. 
• Treatment Delivery Codes
• As noted above, ACRO is concerned about the inappropriate placement of 77407 and 77412 in APC 5622 “Level 2 Radiation Therapy” and will be advocating for the more appropriate placement of (1) 77407 in APC 5623 and (2) 77412 in APC 5624. 
• Other Key Radiation Oncology Codes
• In general, other key radiation oncology codes would see a 5% update relative to last year.

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APPENDIX