Radiation Oncology Billing Updates 2026: Housekeeping List

The code change took most of the attention this year, and it has its own posts. This list is everything else. These are the radiation oncology billing updates for 2026 that a billing office has to act on once, usually on a date, and then leave alone until next year. There are nine items. Each has a trigger, a short explanation and the thing to check. The list was checked on October 22, 2026 against the CMS and CDC sources in the Further reading section, and it is meant to be reused every October with new dates.

If you spent the year working 77387-26 denials and repriced contracts, the smaller items below are easy to miss. None of them is hard. Each one needs a person responsible and a date.

The list at a glance

#	Item	Trigger	Done when
1	FY 2027 ICD-10-CM codes	October 1, 2026	Encoder and treatment-system diagnosis tables carry C78.31, C78.32 and C79.83; D05 with C50 is edited
2	Medicare sequestration	Every Medicare remittance	CO-253 posts as a contractual write-off, never to the patient
3	No Surprises Act	Every self-pay or uninsured course; disputes filed after June 2026	Good-faith estimate template current and the $400 dispute threshold tracked
4	Telehealth and supervision	Now through December 31, 2027	77427 telehealth rules in the scrubber; 77431, 77432 and 77435 in person
5	MIPS 2026 submission	January 4 to March 31, 2027	Data submitted and the confirmation saved
6	The January reload	January 1, 2027; files post in December and early January	RVU, OPPS addenda, HCPCS, NCCI and MUE files loaded before the first January claim
7	Part B deductible and premium	January 1 each year; 2027 figures expected in November 2026	Estimates and front-desk scripts show the current deductible
8	Payer contracts and prior authorization	Contract anniversaries; January 1, 2027 for the prior authorization API	Every anniversary and policy refresh on one list
9	Charge master and Record and Verify tables	After every quarterly file and after the final rule	Treatment-system charge codes match the current code files

1. FY 2027 ICD-10-CM: October 1, 2026

The FY 2027 ICD-10-CM code set applies to encounters from October 1, 2026 through September 30, 2027. It replaced the April 1, 2026 release of the FY 2026 set. The oncology changes are small but they affect radiation oncology directly.

Three new secondary malignant neoplasm codes: C78.31 (larynx), C78.32 (pharynx) and C79.83 (oral cavity). They split out of C78.39 and C79.89. The Neoplasm Table entries for laryngeal structures now point to C78.31 instead of C78.39.
D05 (carcinoma in situ of breast) now carries an Excludes1 note for C50.-, replacing the old Excludes2. In plain terms, a D05.- code and a C50.- code are no longer reported together for the same patient.
A new QA1 family for inherited neoplasm predisposition syndromes: QA1.71 (Lynch syndrome), QA1.790 and QA1.791 (BRCA1 and BRCA2 familial cancer syndromes) and QA1.792 (Li Fraumeni syndrome).
Z51.0 is unchanged. It remains the primary diagnosis for an antineoplastic course, with the neoplasm secondary; see treatment planning and Z51.0.

Check: that the encoder, the EHR problem list and the treatment system’s diagnosis table all updated on October 1. Pull head and neck claims since October 1 that carry C78.39 or C79.89 and ask whether the record supports a new specific code. Add a scrubber edit for D05.- billed with C50.-.

2. Sequestration: every Medicare remittance

The 2 percent sequestration reduction has applied to Medicare fee-for-service claims since April 1, 2013. It was suspended from May 1, 2020 through March 31, 2022, ran at 1 percent from April 1 through June 30, 2022, and returned to 2 percent on July 1, 2022. CMS’s July 2026 payment guidance says the 2 percent rate “remains in effect.”

On the remittance it appears as CO-253, “Sequestration - reduction in federal payment,” on each paid service line. CMS created CARC 253 to replace CARC 223 for this purpose in 2014. The reduction is calculated after the deductible, coinsurance and any Medicare Secondary Payer adjustment, so it comes only out of Medicare’s share. Illustrative: allowed 100.00, deductible met, Medicare share 80.00, CO-253 of 1.60, Medicare pays 78.40, and the patient still owes 20.00.

Check: that CO-253 posts as a contractual adjustment and never moves to the patient or a secondary payer. Confirm your expected-payment table includes the 2 percent. The fuller history and arithmetic are in Medicare sequestration.

3. No Surprises Act: every self-pay or uninsured course

Three parts of the No Surprises Act affect a radiation oncology office in 2026.

Good-faith estimates. Providers must give uninsured or self-pay patients a good-faith estimate of expected charges for scheduled services. If the final bill for that provider is $400 or more above the estimate, the patient can start the patient-provider dispute resolution process within 120 days of the bill. For a course of radiation, the estimate should list the planning codes, the expected number of fractions and the management codes, so a plan change does not become a dispute.
Co-provider charges. HHS has said it is exercising enforcement discretion, pending future rulemaking, where a self-pay estimate leaves out expected charges from co-providers or co-facilities. A hospital department and its physician group are still better served by one combined estimate.
Federal IDR fee. The IDR operations final rules, announced May 28, 2026, set the administrative fee at $15 per party per dispute, down from $115, for disputes initiated five business days after the rules were published. Open negotiation now starts with a notice through the federal IDR portal, and the receiving party must respond by the 15th business day.

Check: the good-faith estimate template carries the current year’s charges and the required patient and date fields. The self-pay flag in scheduling triggers the estimate. One person is responsible for the $400 comparison when a self-pay course finishes.

4. Telehealth and supervision: now through December 31, 2027

The Medicare telehealth flexibilities run through December 31, 2027. Through that date patients can receive telehealth anywhere in the United States, including at home, and audio-only services at home remain payable. Starting January 1, 2028, outside behavioral health, patients will again generally need to be in a medical facility in a rural area.

Two things are permanent and do not depend on the 2027 date. CMS removed the provisional category from the telehealth services list, so every service on the 2026 list is permanent. And for services without a 10 or 90 day global period, direct supervision can be furnished through real-time audio and video. For radiation oncology that means weekly treatment management, 77427, stays a telehealth service with video, while 77431, 77432 and 77435 are not on the list and must be furnished in person. Telehealth claims use POS 02 or POS 10, and home visits pay at the non-facility rate.

Check: the scrubber flags 77431, 77432 or 77435 with a telehealth place of service. Put December 31, 2027 on the compliance calendar now. The detail is in telehealth and supervision in 2026 and CPT 77427.

5. MIPS 2026 submission: January 4 to March 31, 2027

The 2026 performance year ends December 31, 2026. Data for it is submitted from January 4 to March 31, 2027. A final score of 75 is neutral, above 75 earns a positive adjustment and below 75 a negative one, applied to Part B payments beginning January 1, 2028. The last possible 180-day Promoting Interoperability period began July 5, 2026, so that choice is already made. Performance period requirements and attestations close December 31, 2026.

Check: that the person submitting has an active QPP account in December, not in March. Save the submission confirmation. The measures and the specialty set are covered in MIPS 2026 for radiation oncology.

6. The January reload: January 1, 2027

On January 1 nearly every reference file a billing system uses is replaced at the same time.

The fee schedule. CMS lists RVU26A through RVU26D for 2026; RVU27A will arrive with the CY 2027 final rule, which CMS publishes by November 1. The one-year 2.5 percent conversion factor increase from Public Law 119-21 expires for 2027, and the proposed factors are $33.17 (QP) and $32.84 (everyone else), down from $33.57 and $33.40.
OPPS Addenda A and B. Posted quarterly; the October 2026 addenda were updated October 15, 2026. Hospital departments price the delivery codes from Addendum B.
HCPCS. The quarterly file is posted ahead of each quarter; the October 2026 file posted September 23, 2026. The January 2026 file is dated January 12, 2026, after the quarter had started, so do not assume the January file is early.
NCCI PTP edits and MUE tables. New files every January 1, April 1, July 1 and October 1.

Check: no January claim is sent until the fee schedule, the edit tables and the scrubber’s rules are loaded. Rebuild the expected-payment table from RVU27A, not by applying a percentage to 2026. The full set of dates is in the billing calendar, and what the rule changes for our codes is in the 2027 proposed rules post.

7. Part B deductible and premium: January 1 each year

For 2026 the Part B annual deductible is $283, up from $257, and the standard Part B premium is $202.90 a month, up from $185.00. The Part A inpatient deductible is $1,736. CMS released these on November 14, 2025. The 2027 figures had not been released as of October 22, 2026; the pattern is mid-November.

A biller sees the deductible as PR-1 on the first Medicare remittances of January, often across several lines of a course. Eligibility responses show the remaining amount. A patient estimate for a course starting in January should assume the full $283 is unmet unless eligibility says otherwise.

Check: the deductible in estimate templates, front-desk scripts and any patient-responsibility calculator the day the 2027 figures post. Rerun eligibility in the first week of January, because the deductible resets and plan changes take effect then. For the codes on the remittance, see PR-1, PR-2 and PR-3.

8. Payer contracts and prior authorization: anniversaries and January 1, 2027

Many commercial fee schedules are a percentage of Medicare, and some never loaded the 2026 delivery codes at all. Both problems come up at the contract anniversary, which is when a practice can negotiate. Put every contract’s anniversary and notice window on one list and review it; the method is in payer contract readiness and why 2026 payments fell more than CMS projected.

Prior authorization policies for radiation therapy are reissued each January, and courses that cross January 1 need an authorization that covers the new year’s dates. On the federal side, CMS-0057-F now requires Medicare Advantage, Medicaid, CHIP and exchange plans to decide expedited requests within 72 hours and standard requests within 7 calendar days, to give a specific reason for every denial, and to post prior authorization metrics each year starting March 31, 2026. The Prior Authorization API must be in place beginning January 1, 2027.

Check: a January pass through each payer’s radiation therapy authorization policy, using the by-payer guide. Ask the clearinghouse which payer APIs it will connect to in 2027. Keep each plan’s denial-reason text; it is what you appeal against.

9. Charge master and Record and Verify tables: after every quarterly file

Most radiation oncology charge codes come from the treatment system’s charge table or the hospital charge master, not from the billing system. Those tables did not update automatically on January 1, 2026, and they will not update automatically on January 1, 2027 either. Record & Verify import from Aria and Mosaiq (Record & Verify integration) brings charges in from the treatment system; the practice must maintain the charge codes in the R&V system.

Check: after each quarterly file, compare one week of imported charges against the current CPT and HCPCS files and the MUE table. After the CY 2027 final rule, check the delivery, guidance and management lines again. The one-week review is in Record and Verify charge capture after the 2026 code change, and the codes themselves are in the 2026 code changes post.

Repeat it next October

The nine items do not change from year to year; only the dates and the figures do. Each October, after the new ICD-10-CM set takes effect and before the final rules post, review the table once, assign a person to each row, and write the new dates in. It takes about an hour and prevents problems in January.