Proposed 2016 Medicare Physician Fee Schedule (MPFS) rules promise to keep many specialty providers and healthcare administrators on their toes.Detailed information is available on the CMS web site.
In terms of cancer care, hematology oncology providers should have 0% financial impact. 
Facility based radiation oncology providers could see a reduction of 3% in reimbursements.
Free-standing RT centers might go as high as 9%.
Some billers of radiation oncology services are still reeling from the confusion regarding the 2016 temporary codes Medicare required for free standing centers while wanting CPTs for facilities. I hear of lingering payment issues with commercial and Medicaid payers who were unreliable in applying the Medicare guidelines for the new codes.
Rates for treatment delivery codes and image guidance have been proposed for CY2016 which should eliminate the use of the G codes (G6001-G6017).
Iridium Suite customers can run a practice analysis report: Procedure Code Stat report. They can use the number of each treatment delivery code or image guidance code from each “bundled” group to calculate the financial impact on their practice. If we use Bundle 3 below as an example:
Code # Billed $ Billed
G6011 250 $69,832.50
G6012 835 $191,131.50
G6013 468 $120,575.52
G6014 699 $180,090.36
2015 Total $561,629.88
2016 Total $482,220.76
Reduction of $79,409.12, Approx. -14%
Bundle 1: CPT code 77402 will represent procedures previously billed as 77402(G6003), 77403(G6004), 77404(G6005) and 77406(G6006). The 2016 rate is proposed to be $139.02. (In 2015 77402=$162.42, 77403=$125.77, 77404=$140.50, 77405=$139.78.)
Bundle 2: CPT code 77407 will represent procedures previously billed as 77407(G6007), 77408(G6008), 77409(G6009) and 77411(G6010). The 2016 rate is proposed to be $240.13. (In 2015 77407=$258.36, 77408=$173.92, 77409=$192.60, 77411=$192.60.)
Bundle 3: CPT code 77412 will represent procedures previously billed as 77412(G6011), 77413(G6012), 77414(G6013) and 77416(G6014). The 2016 rate is proposed to be $214.13. (In 2015 77412=$279.33, 77413=$228.90, 77414=$257.64, 77416=$257.64.)
Note:Instead of bundling, CPT code 77418 will be split into two codes based on complexity: 77385 and 77386. The 2016 rates are proposed to be $279.49(77385) and $421.04(77386). (In 2015 77418=$402.10.)
Bundle 4: CPT code 77387 will represent procedures previously billed as 77014, 76950(G6001) and 77421(G6002). The 2016 rate is proposed to be $211.24. (In 2015 77014=$117.86, 76950=$51.74, 77421=$75.46.)
Additional items from the 2016 proposed PFS, the agency would:
- Review 118 potentially miss-valued codes, including a number of codes related to cancer care
- Create two new G-codes for lung cancer screening with proposed values cross-walked from existing CPT codes
- Add additional requirements for physicians to bill services provided by auxiliary personnel "incident to" the physicians' services
http://accc-cancer.org/advocacy/pdf/2016-CMS-PFS-Proposed-Rule-ACCC-Summary.pdf
