On April 10, 2024, the Centers for Medicare and Medicaid Services (CMS) issued the Inpatient Prospective Payment System (IPPS) proposed rule. The proposed rule updates the Medicare reimbursements under IPPS by 2.6% (a 3.0% market basket update with a -0.4% productivity adjustment).

Why it matters: While radiation therapy reimbursement is typically tied to the Medicare Physician Fee Schedule (MPFS) or the Hospital Outpatient Prospective Payment System (HOPPS), the IPPS proposed rule often includes items of interest to radiation oncology related to new technologies and quality reporting. It also provides a preview of policy proposals, which may appear in the MPFS and HOPPS proposed rules this summer.

Items of interest in the 2025 IPPS proposed rule include:

• Intraoperative Radiation Therapy (IORT)
• Proposed changes to the Hospital Wage Index for acute care hospitals
• Proposed continuation of the Low-Wage Hospital Policy
• Proposed changes to the PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program
• Hospital Inpatient Quality Reporting (IQR) Program
• New Technology Add-On Payments (NTAP) for new services and technologies
• CMS Specialty Care Strategy: TEAM Model
• Social Determinants of Health Diagnosis (SDOH) Codes

Read ASTRO’s summary for more information.