ASTRO presses Congress on radiation oncology payment cuts

Radiation oncologists are urging Congress to address Medicare reimbursement cuts and prior-authorization policies they say are threatening access to cancer care.

Members of the American Society for Radiation Oncology visited Capitol Hill on April 27 to advocate for payment reform and Medicare Advantage prior-authorization changes. ASTRO said the advocacy push comes as recent Medicare policy changes and private payer tactics are pushing some cancer clinics toward closure.

The society is asking lawmakers to support the Radiation Oncology Case Rate Act, known as ROCR, and the Improving Seniors’ Timely Access to Care Act. ASTRO said both bills are intended to protect patient access, reduce administrative barriers, and create a more stable payment environment for radiation therapy services.

The payment concern centers on Medicare changes to radiation treatment delivery codes that took effect in 2026. ASTRO has said the changes have produced sudden reimbursement drops for many practices, particularly community-based cancer clinics with high equipment, staffing, and facility costs.

A national ASTRO physician survey found that more than 2-thirds of respondents reported double-digit reimbursement declines after the coding changes. The society also said Medicare reimbursement for radiation therapy has fallen 27% since 2013.

“Radiation therapy is a cornerstone of modern cancer treatment,” Sameer Keole, MD, chair of ASTRO’s board of directors, said in an earlier ASTRO statement about the 2026 Medicare changes. He warned that the cuts could be “potentially catastrophic” for patient access.

ROCR would shift Medicare radiation oncology reimbursement away from a per-treatment model toward episode-based payment tied to individualized patient treatment plans. Supporters argue that this would better align payment with clinical value rather than the number of fractions delivered.

ASTRO said the bill has bipartisan support and backing from nearly 140 organizations. The society’s legislative priorities for Advocacy Day also included holding Medicare Advantage insurers accountable for prior-authorization delays and denials.

Prior authorization is the second major target of the advocacy push. ASTRO said radiation oncologists are backing the Improving Seniors’ Timely Access to Care Act, which would add transparency and timeliness requirements for Medicare Advantage prior authorization.

The society has argued that prior authorization for radiation therapy does not produce meaningful savings and may delay care. In radiation oncology, delays can be especially consequential because treatment often follows diagnosis, staging, simulation, and treatment planning, all of which already require careful coordination.

The broader issue is access. Community radiation oncology clinics often serve patients close to home, including older adults and patients in rural or underserved areas. If reimbursement falls below the cost of care, ASTRO argues, clinics may reduce services, delay investments, consolidate, or close.

The pressure also comes during a period of increasing cancer burden and rising operational costs. Radiation oncology depends on expensive linear accelerators, treatment-planning systems, quality-assurance processes, physicist support, radiation therapists, dosimetrists, nurses, and physicians. Payment instability therefore affects more than physician revenue. It can affect the full care-delivery infrastructure.

Congress has not yet passed either bill. For radiation oncology groups, ASTRO’s Capitol Hill visit signals that payment reform and prior-authorization reform will remain central policy priorities in 2026.