Determining if you are an RO Model Participant?

Determining if you are an RO Model Participant?

1. You bill Radiation Therapy services to Medicare patients.
2. RO Model participation is required for a list of randomly selected zip codes. If the facility you are delivering services from fall in this zip code list, then you are a participant.

RO Model Zip codes: https://innovation.cms.gov/media/document/ro-model-zip-codes-list-nov2021

A RO participant can be either:

1. Professionally billing physicians or Physician Group Practices

   This includes freestanding centers as well as physicians working in a hospital but billing the professional service side.

2. Institutional environment

This includes hospital radiation therapy departments.

Participant Types:

1. A Professional participant is a Physician Group Practice, that furnishes only the professional component (PC) of RT services at either a freestanding radiation therapy center or a HOPD.  These services are often accompanied by a 26 modifier.
2. A Technical participant is a HOPD or freestanding radiation therapy center which furnishes only the technical component (TC) of RT services during an RO episode.
3. A Dual participant are global billers who furnish both the professional and technical components of a Radiation Oncology episode for RT services through a freestanding radiation therapy center.