Standing with Members Through Change

There is a great deal happening at ASTRO, but I want to begin with what is most top of mind for many of our members: the new radiation therapy delivery codes that took effect on January 1, 2026.

We recognize that the transition has been disruptive and stressful for practices across the country. ASTRO has been actively engaged with payers, utilization management companies, and other stakeholders to help ensure these codes are implemented as intended.

It is important to emphasize that ASTRO did not initiate this process. We were asked by the AMA’s Relative Value Update Committee (RUC) in September 2023 to lead a comprehensive re-evaluation of the radiation therapy delivery code set. Under the new framework, treatment delivery is no longer defined by energy or whether therapy is categorized as 3D or IMRT. Instead, the key distinction is the overall complexity of delivery, including the amount of time, number of isocenters, and motion management. The revised codes now include the costs of image guidance. This approach applies regardless of whether the condition being treated is malignant or nonmalignant.

As part of this restructuring, three new external beam delivery codes were created: 77402, 77407 and 77412 (these code numbers were previously used but have now been assigned new definitions). We anticipate that most treatments, more than 90%, will fall under 77407 or 77412.

The primary difference between these two codes is treatment time. Code 77412 was designed to capture scenarios requiring additional time and complexity, including active motion management, multiple isocenters and total skin electron therapy. These situations require greater resources and were intentionally structured to be reimbursed appropriately.

There has been considerable discussion regarding what constitutes active motion management and what is required for appropriate delivery. ASTRO provided education on the revised codes through its Coding Resource (available for purchase at ASTRO.org) and Coding seminar in December 2025 (now available on the ASTRO Academy).

In the meantime, we continue to make meaningful progress through ongoing dialogue with payers and utilization management organizations. Some challenges stem from delayed software updates, while others reflect differing interpretations of code language. Our consistent position remains clear: the CPT language should be followed as written.

While coding uncertainty affects all practices, it is particularly challenging for smaller and freestanding radiation oncology groups that may be less able to absorb sudden reimbursement disruptions. ASTRO has made this concern clear to payers and continues to advocate strongly on behalf of our members.

Beyond coding, ASTRO is also investing in the future of the field. The Economics of Oncology project is now underway following the award of a nearly $1 million grant to investigators within the Harvard Medical School system. This independent, two-year academic effort aims to rigorously evaluate the value of radiation therapy, with results expected by late 2027.

Advocacy efforts around the Radiation Oncology Case Rate (ROCR) legislation also continue. The bill maintains bipartisan, bicameral support in Congress, and we’re off to a great start in 2026, adding cosponsors on the key congressional committees. While legislative progress remains challenging in the current environment, we are already seeing early signs of impact, including alignment of ROCR’s payment methodology and CMS’ decision to use hospital payment rates to inform freestanding rates for the revised treatment delivery codes. This represents a significant step forward for the field and reinforces the importance of continued advocacy.

Finally, we are working to improve the member experience through initiatives such as a planned modernization of the ASTRO website to better meet the needs of an increasingly mobile-first audience.

We recognize that this is a period of significant change for our field. Please know that ASTRO remains fully engaged and committed to advocating for fair implementation of the new codes and for the long-term stability of radiation oncology while continuing to focus on advancements to improve member experience.