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Radiation Oncology Case Rate Program (ROCR)

The Radiation Oncology Case Rate (ROCR) Value-Based Payment Program Act was introduced by Sen. Thom Tillis (R-NC) in the US Senate and Reps. Brian Fitzpatrick (R-PA), Jimmy Panetta (D-CA), John Joyce, MD (R-PA), and Paul Tonko (D-NY) in the House of Representatives in May 2024. The ROCR Act is a bipartisan legislative initiative designed to reverse disastrous Medicare Part B payment trends that are expected to continue without any intervention. ASTRO believes that the ROCR Act represents the best chance to secure long-term rate stability and continue to deliver cutting-edge care to our patients close to home. View the organizations that support ROCR. If you would like your organization included on the ROCR support letter to Congress, please complete the ROCR Support Form.

ROCR would:

  • Change radiation oncology payment from per fraction to per patient.
  • Reverse decade-long declines in Medicare payments.
  • Usher in a new era of stable payments, higher quality care and reduced disparities.

Developed by ASTRO’s Health Policy Council, physician leaders from various practice settings and with the help of expert consultants, the ASTRO Board approved ROCR as a legislative proposal in June after numerous versions were evaluated and analyzed.

ROCR seeks to achieve the following:

  • Address the instability of the current payment systems
  • Use a more simplified approach than the CMS RO Model
  • Align financial incentives with clinical guidelines
  • Ensure use of quality assurance and improvement standards
  • Reduce disparities by helping underserved patients initiate, access and complete treatments
  • Unify payment that levels the playing field across care delivery settings
  • Update payments annually based on medical inflation trends

For more information about ROCR, check out this article and watch the recorded webinar.

ROCR Town Hall

On Friday, July 21, 2023, ASTRO hosted a Town Hall to discuss the newly released Radiation Oncology Case Rate (ROCR) Program and answer questions from attendees. The panelists provided insights on the results of their use of the ROCR modeling tool, the importance of ROCR as an alternative to Fee-for-Service, and common questions voiced by ASTRO members.


  • Casey Chollet-Lipscomb, MD - Tennessee Oncology - ASTRO Government Relations Council Vice Chair
  • Join Y. Luh, MD, FACP, FACR, FASTRO - Providence Health
  • Constantine Mantz, MD, FASTRO - GenesisCare - ASTRO Health Policy Council Chair
  • Michael Milligan, MD, MBA - Spectrum Healthcare Partners


How will ROCR Impact My Practice?

ASTRO has developed modeling tools so that practices can determine ROCR’s impact. Practices are encouraged to compare their existing Medicare FFS rates with the ROCR rates.

ROCR Pricing Model Professional Component
ROCR Pricing Model Technical Component


Want to know more?

Policy Paper
Technical Document

Can I give ASTRO feedback?

ASTRO is seeking feedback on ROCR with the goal of securing broad support from the radiation oncology community before advancing this legislative proposal in Congress.

If you have any questions about ROCR, please contact Anne Hubbard, Director of Health Policy.

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