The ROCR Act explained for radiation oncology billers: episodes, HEART payments and what would change at the front desk
The Radiation Oncology Case Rate (ROCR) Value Based Program Act of 2025 would end per-fraction Medicare billing for most external beam radiation therapy and replace it with two payments per episode of care, the same amount in a hospital department or a freestanding center. It is a bill, not a law: H.R. 2120 in the House and S. 1031 in the Senate, with no CMS rulemaking behind it. It still matters to billers. It is the specialty’s main response to the 2026 code cuts, and if it passes, nearly every workflow in this article’s companion pieces will change.
The outline of the ROCR Act radiation oncology groups have been promoting is below, drawn from the introduced bill text rather than from summaries.
Where it stands
| House | Senate | |
|---|---|---|
| Bill | H.R. 2120 | S. 1031 |
| Introduced | March 14, 2025 | March 13, 2025 |
| Sponsor | Rep. Brian Fitzpatrick (R-PA) | Sen. Thom Tillis (R-NC) |
| Original cosponsors | Reps. Jimmy Panetta (D-CA), John Joyce (R-PA), Paul Tonko (D-NY) | Sen. Gary Peters (D-MI) |
| Referred to | Energy and Commerce; Ways and Means | Finance |
ASTRO publicly endorsed the bill at reintroduction, and the sponsors said more than 80 organizations supported it. As of this writing neither bill has become law, and CMS has issued no ROCR regulation. The CMS Innovation Center’s Radiation Oncology Model page still shows that model delayed “to a date to be determined through future rulemaking” under the August 29, 2022 final rule (CMS-5527-F2), after Public Law 117-71 barred it from starting before January 1, 2023. ROCR is written to replace the RO Model.
How an episode would work
Participation is mandatory for Medicare providers and suppliers furnishing covered radiation therapy, with case-by-case hardship exemptions and an opt-in for providers already in a state-based Innovation Center model.
A planning code starts the episode. An episode begins when treatment planning (77261, 77262 or 77263) is furnished and treatment starts within 30 days. The episode runs 90 days, or 30 days for bone and brain metastases.
Fifteen cancer types are included: anal, bladder, bone metastases, brain metastases, breast, cervical, central nervous system tumors, colorectal, head and neck, lung, lymphoma, pancreatic, prostate, upper gastrointestinal and uterine.
Two case rates, same in every setting. There is a professional episode amount and a technical episode amount, each built from the RO Model’s M-code national base rates in the November 16, 2021 Federal Register table, geographically adjusted, with a “savings adjustment” percentage applied. The bill states that the per-episode amount “shall not change depending on the site of service.” Professional rates update by the Medicare Economic Index, technical rates by the hospital market basket; rates cannot fall below the prior year’s, and rebasing every five years can reduce them by no more than 1 percent.
Payment comes in halves. Half of each amount is paid within 30 days of the first treatment; the rest at the scheduled end of treatment or day 90 (day 30 for bone and brain metastases), whichever is earlier. If the patient dies during treatment, both halves are paid within 30 days of the final treatment.
Excluded for 12 years: brachytherapy, proton beam therapy, intraoperative radiotherapy, superficial radiation therapy, hyperthermia and therapeutic radiopharmaceuticals, which would keep billing fee-for-service.
Coinsurance stays at 20 percent, now of the episode amount. Providers may offer payment plans but may not market them.
The HEART add-on and the transportation exception
The Health Equity Achievement in Radiation Therapy (HEART) add-on pays the technical provider $500 per patient per episode in the program’s first year, rising $10 each year after. It is triggered when the patient’s intake screening identifies transportation insecurity and ICD-10 code Z59.82 is reported: the patient says unreliable transportation kept them from appointments, work or daily activities in the prior two months. The money is meant to fund rides, and a companion provision adds a civil monetary penalty exception so a radiation provider can offer free or discounted ground transportation (not air, luxury or ambulance) to established patients who live within 75 miles or in a rural area, applied uniformly and not marketed.
For a front desk, a screening question would then affect payment, and the Z59.82 code would need to be captured reliably.
Quality, MIPS and the rate freeze
- Providers accredited by ACR, ACRO or ASTRO (and meeting EHR standards) receive a 1 percent technical increase for two years; after that, unaccredited providers take a 2.5 percent reduction per episode, with a limited-resource exception capped at 10 percent of providers.
- Participants are excluded from MIPS.
- Program savings are exempt from fee schedule and OPPS budget neutrality.
- From enactment until the regulations take effect, CMS may not reduce existing fee schedule or OPPS radiation therapy rates. Regulations are due within one year of enactment, with an advance notice and a proposed rule, each with at least 60 days for comment.
Worked example: a prostate course today and under ROCR
A 20-fraction, single-isocenter IMRT prostate course at a freestanding center.
| Today (2026 codes) | Under ROCR as introduced | |
|---|---|---|
| Planning | 77263, 77301, dosimetry and device codes, billed as performed | 77263 starts the 90-day episode; planning is inside the case rate |
| Delivery | 20 units of 77407 | Inside the technical case rate |
| Image guidance | 20 units of 77387-26 | Inside the professional case rate |
| Management | 4 units of 77427 | Inside the professional case rate |
| Claims | Dozens of lines across the course | Two professional and two technical payments: half within 30 days of fraction 1, half at the end |
| Patient share | 20 percent of each allowed line | 20 percent of the episode amounts |
| Add-on | None | $500 HEART payment to the technical provider if Z59.82 is documented at intake |
A bone metastasis course would work the same way over a 30-day episode. A superficial skin course, or a brachytherapy boost, would stay fee-for-service.
What to do now
- Nothing changes on claims until a law passes and CMS writes rules, which the bill gives CMS a year to do. Keep billing the 2026 codes correctly.
- Read the companion RO Model material. ROCR borrows the RO Model’s episode trigger, cancer list, M-code base rates and split payments; the RO Model resources at /ro-model-billing/ describe that episode workflow, and Iridium Suite’s built-in RO Model configuration automated the M-code and modifier billing for it when the model was scheduled to start.
- Add a transportation screening question to intake now and code Z59.82 when it applies. It costs nothing today, and staff will already be doing the step the HEART payment would pay for.
- Keep accreditation current. The 1 percent bonus and later 2.5 percent reduction would tie ACR, ACRO or ASTRO accreditation directly to payment.
- Track the bills. The cosponsor counts and any attachment to a broader physician payment package are the signals to watch.