RO Model – Included vs Excluded Services
Included Services
These services are considered to be included with RO Model billing. Since they are bundled with the RO Model M-Codes, they are not paid separately.
- Treatment planning
Determining treatment modality, parts of the body that must be radiated, and plan for RT (e.g., RT Planning)
- Technical preparation and special services
Technical preparation to confirm radiation dosing is accurate, machine is prepared, and treatment aids are constructed (e.g., RT Aids)
- Treatment delivery
Radiation delivered to patient in one or more sessions (e.g., RT Delivery)
- Treatment management
Patient monitoring and treatment adjusted according to outcomes (e.g., RT Management x 5 Treatments)
Excluded services
These services are expected to continue to be billed and reimbursed in the traditional Fee For Service (FFS) method.
- Initial consultation (typically billed using E&M service)
- Experimental and low volume treatments (neutron beam, hyperthermia)
- General imaging not related to radiation prep
- RT furnished in any setting other than a HOPD or freestanding RT center
- Radiopharmaceuticals
- Intra-operative RT
- Brachytherapy services
