On Friday, October 31, 2025, the Centers for Medicare & Medicaid Services (CMS) issued the 2026 Medicare Physician Fee Schedule (MPFS) final rule, with an estimated -1% cut to radiation therapy physician services; however, due to statutory increases not reflected in the rule’s specialty impact table, radiation oncology will see a net positive impact. ASTRO is pleased that CMS made improvements to its initial proposal to use hospital outpatient payments to inform freestanding payments; however, ASTRO is disappointed the Agency finalized the new efficiency adjustment that cuts reimbursement for physician work.

Final Rule Takeaways for Radiation Oncology

• Final Rule’s estimated impact on radiation oncology: -1%; however, due to statutory increases not reflected in the specialty impact table, radiation oncology actually will see a net positive impact.
• 2026 conversion factor increase of 3.77% for qualifying APM participants and 3.23% for non-qualifying APM participants.
• Revised radiation treatment delivery and superficial radiation therapy (SRT) code set valuations informed by hospital outpatient payment system (OPPS) data.
• Use of existing practice expense survey data avoids potential 40% cut.
• New efficiency adjustment implemented, cutting many radiation oncology codes.
• Flexibility to provide direct supervision using two-way audio/visual communication made permanent.

Read ASTRO’s Final Rule Summary for a thorough analysis.