Payers Fail to Reset Radiation Oncology Payments to Match Coding Changes—and Some Clinics May Close, Leading Oncologist Says

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Key Takeaways

Consolidation of long-standing radiation treatment delivery CPT codes increased the work captured per code, making repricing essential to maintain revenue neutrality as services previously billed separately became bundled.
Commercial fee schedules often were not updated despite advance outreach, yielding materially lower payments for the same treatment delivery and creating immediate cash-flow stress for independent clinics.
ASTRO survey results indicated over two-thirds of respondents experienced reimbursement cuts of at least 10%, with some reporting substantially steeper declines.
Contract language limits CMS leverage over commercial payers, while delayed repricing creates a “perverse incentive” for insurers to realize short-term savings.
Ongoing underpayment is framed as an existential threat to community-based and rural radiation oncology, with closures or hospital absorption likely increasing total costs and travel burdens for fractionated care.

Todd Doyle, MD, of OneOncology, warns that commercial payers lag on updating bundled codes, which has slashed radiation oncology revenue and risks community cancer access in 2026.

Throughout fall 2025, radiation oncologists and CMS debated a Medicare Physician Fee Schedule (PFS) that sought streamlined billing by bundling several reimbursement codes. While opinions differed and the plan projected an overall cut of 1%,¹ there was agreement on this point: The codes would need to be repriced, and commercial payers should be prepared.

It turns out they weren’t. Radiation oncologists have told The American Journal of Managed Care^® (AJMC^®) that several large payers failed to update payments to align with codes that now cover different services, and independent clinics are paying the price.² Depending on the location, revenue is down up to 30% or 40% in the first quarter of 2026, threatening clinics’ financial health and patient access, according to both a leading radiation oncologist and a professional association that recently surveyed its members.

Results released April 1, 2026, by the American Society for Radiation Oncology (ASTRO), which represents more than 10,000 specialists in the field, found that more than two-thirds of physicians surveyed reported reimbursement cuts of 10% or greater, with many reporting steeper declines.³

Todd Doyle, MD, president of New York Oncology Hematology and chief of radiation oncology for OneOncology, told AJMC in an interview that this revenue chasm has occurred despite practices and clinics’ efforts to educate payers about the coding changes before they took effect on January 1, 2026.

Essentially, he said, payers have a decision: They can reprice 3 long-standing Current Procedural Terminology (CPT) codes used in radiation treatment delivery, as they did when codes were bundled, or they can watch the radiation oncology infrastructure crumble. Doyle explained that the American Medical Association (AMA) updated the codes to bundle in services previously billed separately, and repricing is needed to reflect the costs of delivering labor-intensive services with today’s advanced technologies.²

CMS, he said in an interview, adopted a Medicare PFS that reflects the new structure. Still, beyond Medicare Advantage, it typically has little ability to compel commercial payers to act because payments are based on language in individual contracts. Doyle declined to name individual payers involved, saying he’s trying to work with them to show that allowing clinic failures is not in their long-term financial interest.

He believes CMS had “the best of intentions” in moving to simplify the treatment delivery codes. “Over the past decade or more, the delivery of radiation has become increasingly complex—and that’s good because it delivers more accurate care for patients,” Doyle said. “But as it became more complex, and the work to deliver that more complex treatment became more intensive, new codes had to be created during that period to represent the work that was being done to deliver that very precise care.”

Thus, the point was to simplify billing into 3 codes—simple, intermediate, and complex—while bundling associated work into what Doyle called 3 “buckets,” which would then be revalued and followed by appropriate payments.

The first part happened. In too many cases, the second part has not, and when radiation oncologists submit codes that should now capture more work—and money—they receive a fraction of the payment they are owed. While Medicare has worked to reprice the affected codes, Doyle said, “The private payers did not go in and update their fee schedules.”

“And so, this is a huge hit to the world of radiation oncology.”

Doyle described proactive efforts to meet with payers before the end of 2025. Yet, as early as February 5, 2026, ASTRO posted letters regarding comments to CMS on this issue, and a town hall is scheduled for May 6, 2026.⁴

Is this just an error? Did someone drop the ball?

“The answer is, it’s really the private payers that dropped the ball here,” Doyle said. “We at the network went out to all of the top payers in every one of our markets ahead of time, back in November and December, and said: ‘This is coming. You know this is coming; you need to update your systems.’”

Doyle said OneOncology representatives even asked if physicians would need to obtain new authorizations for patients who were in the middle of a treatment course, to ensure there would be no interruption. “Some said yes, some said no—and even the ones when they said no, then went back and denied those [claims] afterward,” Doyle said. “It was a huge dropping of the ball that [the payers] didn’t revalue their codes.”

It’s hard to account for why this happened, but Doyle added, “There’s a little bit of a perverse incentive to drag your feet on this, because the more you do, there are huge savings to the insurers if they haven’t revalued [the codes].”

What do clinics do until this is resolved? “I don’t want to be dramatic here, but this is truly an existential threat to community-based radiation oncology and cancer care in more rural community settings,” Doyle said, noting that hospital-based systems bill under a different system and are not threatened.

He explained that in many contracts, payers are not obligated to update pricing to a revenue-neutral policy. But failure to do so will create access issues, which will only increase costs in the long run.

“We’re not asking for an increase. We’re just asking for revenue-neutral, 2025, pay us for the same amount in 2026 for the same service,” he said. “And retroactively, go back and do that to January 1, because we’re already in a hole in many of these clinics.”

Any absorption by a hospital system will raise costs, and any clinic closure will force patients to drive longer distances for care. Given the way radiation treatments are delivered, long drives impede patient care. “Now they’re driving 30 minutes, 60 minutes every day for 6 weeks to get their care,” he explained.

“Quite honestly, even the damage that’s been done already is enough,” Doyle said.

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