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Proposed Payment Rates

Tuesday, August 4, 2020   (0 Comments)
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As many of you are aware, today CMS released the OPPS Proposed Rule Update.  Below are the Proposed Payment Rates for the proton treatment delivery codes.

 

Proposed Payment Rates

There were no policy changes proposed that were directly relevant to proton therapy. In terms of the rates themselves, the rates are proposed to increase by between 3 – 5% for the proton therapy delivery codes (note that we often see incremental change between proposed and final rules). The table below gives the details:

HCPCS Code

Short Descriptor

2021 Proposed APC

2021 Proposed APC Descriptor

2021 Proposed Payment Rate

2020 Final Payment Rate

Payment Rate, Difference
2021 Proposed - 2020 Final

Payment Rate,
% Difference
2021 Proposed / 2020 Final

77520

Proton trmt simple w/o comp

5623

Level 3 Radiation Therapy

$ 554.43

$ 538.83

$15.60

2.9%

77522

Proton trmt simple w/comp

5625

Level 5 Radiation Therapy

$ 1,308.19

$ 1,246.76

$61.43

4.9%

77523

Proton trmt intermediate

5625

Level 5 Radiation Therapy

$ 1,308.19

$ 1,246.76

$61.43

4.9%

77525

Proton treatment complex

5625

Level 5 Radiation Therapy

$ 1,308.19

$ 1,246.76

$61.43

4.9%

77371

Srs multisource

5627

Level 7 Radiation Therapy

$ 7,938.28

$ 7,942.41

-$4.13

-0.1%