Commonly asked questions about the Medicare Radiation Oncology Model billing guidelines What are the billing guidelines for the Radiation Oncology Model? RO Model participants must submit claims under the existing Medicare claims system according to the RO Model billing instructions described in the CMS final rule . In addition, RO participants must submit “no-pay” claims for all radiation therapy services furnished in the episode. What are the approved cancer types? The RO Model covers 15 cancer types. These cancer types are commonly treated with radiation therapy under nationally recognized, evidence-based guidelines and are associated with ICD-10 codes that have demonstrated pricing stability. What are the approved modalities of treatment? Modalities covered under the RO Model include three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, stereotactic radiosurgery, stereotactic body radiotherapy, proton beam therapy and image-guided radiation therapy. W

Check your participation status and build your plan Are you a hospital outpatient department, physician group practice or freestanding clinic providing radiation therapy services? If so, you may be required to adopt the new mandatory Radiation Oncology Model. Mandatory participation is randomized by Core-based Statistical Areas. You can check your organization’s participation status online. CMS released the Final Rule for the RO Model, giving providers 60 days to prepare for program launch on January 1, 2022. If your organization performs radiation therapy in a ZIP code on the list, you will need to begin preparing for the model.