New Payment Policy: Intensity Modulated Radiation Therapy and Proton Beam Therapy

Effective October 3, 2025, a new payment policy for Intensity Modulated Radiation Therapy (IMRT) and Proton Beam Therapy, specifically focusing on outpatient facility claims, will be implemented within claim editing. This new policy outlines how services considered included in IMRT treatment plans will be recognized and reimbursed when submitted on an outpatient facility claim.

Effective for claim dates of service on and after October 3, 2025, several CPT procedure codes will be considered inclusive to CPT procedure code 77301 (IMRT planning) when submitted by the same facility within 30 days before or after the IMRT planning procedure.  These codes include: 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77313, 77317, 77318, 77321, 77331, and 77370.

This policy aligns with the American Society for Radiation Oncology (ASTRO) guidelines and the Centers for Medicare and Medicaid Services (CMS) claims processing manual on how to correctly bill for IMRT services. These codes shouldn’t be reported separately if performed as part of developing an IMRT treatment plan.

For further information, review the details of the policy.