We’re halfway through 2026, and the financial impact of a significant coding change will soon be hitting home for many radiation oncology providers. 

As part of a broader effort to simplify coding and cut costs, CMS restructured the federal payment schedule for certain radiation therapies, and these updates took effect on January 1, 2026. Commercial payors have largely followed CMS's lead, updating their own reimbursement schedules to reflect these changes.

For providers, this isn't simply an administrative update. It has the potential to dramatically reduce reimbursement for some of the most commonly billed radiation therapy services. In our discussions with providers, we've found that while many organizations know the code changes occurred, few fully understand how transformative they will be. 

In reality, we’ve already seen payments decrease by up to 62% for therapies reimbursed under these codes. For one client, we project the annual impact will exceed $7.5 million, a loss that could threaten the viability of even well-established cancer programs. As Dr. Sameer Keole, Chair of the ASTRO Board of Directors, warned, this is a “serious and immediate threat to cancer care in the United States.”

How We Got Here

To better understand why these code changes took place, it helps to review some history. Between 2002 and 2014, radiation oncology spending increased significantly as intensity-modulated radiation therapy (IMRT)—a more precise form of radiation treatment—became the standard of care for a growing number of patients.

In 2014, CMS concluded that reimbursement for many of these services had become overvalued and called for a new payment approach. Over the following decade, reimbursement reductions were proposed while advocacy organizations, including ASTRO, pushed Congress to adopt broader payment reform. Those efforts have yet to result in lasting legislative changes. Instead, beginning in 2026, several long-standing radiation oncology codes were discontinued and replaced with repurposed codes that carry substantially different (and lower) reimbursement levels. In total, eight high-volume codes are affected: four discontinued and four reinstated.

With payors quickly adopting these new codes without payment renegotiation, providers across the country are either experiencing or will soon experience downstream financial consequences.

Why Providers Should Pay Attention

These aren't niche billing codes. They represent services performed every day in cancer centers, hospitals, and physician practices. If your organization is billing the replacement codes without addressing how your contracts reimburse them, there's a strong possibility you will be paid significantly less than you were before January 1.

Dr. Keole paints a cautionary picture of what's ultimately at stake: “These cuts are potentially catastrophic for patient access across the county. When these centers are forced to scale back, close, or consolidate, patients don’t stop needing care. It just becomes harder for them to find and complete it.” Providers will need to act quickly to protect the financial resources needed to continue delivering this cancer care in the communities that depend on it.

If you're unsure how these coding changes will affect your organization, now is the time to review your contracts, assess the impact, and determine whether your reimbursement will adequately cover the services you provide.

A Window to Act

Although these reimbursement changes are already taking effect, providers are not without options. Organizations that identify the financial impact early are in a much stronger position to respond before reimbursement losses continue to accumulate.

The first step is understanding exactly how these coding changes will play out for your organization. In as little as 7–14 days, After Transparency can provide a detailed analysis comparing your discontinued 2025 radiation oncology codes with their 2026 replacements, quantify the reimbursement impact across your payor contracts, and identify where significant revenue may be at risk. Armed with that information, you'll be equipped to effectively negotiate with payors to reestablish fair reimbursement for these treatments.

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Let’s Talk: After Transparency is a Nashville-based analytics firm specializing in payor price transparency data. Rather than handing clients massive datasets and expecting them to find the answers, we work alongside providers to understand their strategic priorities, payor mix, geography, and key service lines. The result is clear, decision-ready intelligence that helps organizations navigate complex reimbursement challenges with confidence. If you'd like to understand how these radiation oncology coding changes are affecting your organization, then book a meeting with us today. 

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