On Wednesday, November 4, 2026, the Centers for Medicare and Medicaid Services (CMS) released the CY 2027 Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Prospective Payment System (OPPS) final rules. Both rules take effect January 1, 2027 and will have significant impact on proton therapy providers, both hospital-based and freestanding centers.
Hospital Outpatient Prospective Payment System (OPPS)
CMS finalized increases to hospital outpatient payment for most proton therapy services. This is largely because CMS finalized a reduction in payment for drugs that hospitals buy at a discount through the federal 340B program. By law, this policy must be budget neutral. The savings are therefore redistributed to other hospital outpatient services, increasing payment for non-drug services, including radiation oncology and proton therapy.
As a result, the most commonly billed proton treatment codes (77522, 77523, and 77525) will be paid $1,465.20 in CY 2027, a nearly 15% increase over CY 2026 rates. The 340B redistribution could change in future years, and accurate charge capture and cost reporting remain essential to protecting future hospital rates.
Read our executive summary of the OPPS final rule here.
Medicare Physician Fee Schedule (MPFS)
For the first time, CMS has established national Medicare payment rates for proton therapy delivered in freestanding centers. These centers have historically been paid at rates set locally by regional Medicare contractors. The National Association for Proton Therapy (NAPT) recognizes the significance of this change and supports a more consistent and predictable national payment structure. However, we remain concerned that the final methodology does not adequately reflect the unique costs and resources required to deliver this highly specialized cancer treatment.
We appreciate that CMS increased payment for the most commonly billed proton treatment codes by 10% from the proposed to the final rule, though the final rate of $1,132.21 per treatment is nearly 23% below the $1,465.20 Medicare will pay hospital outpatient departments for the same service.
CMS has acknowledged the important role proton therapy plays in treating Medicare beneficiaries, as well as the potential implications of reimbursement policy for patient access and providers’ ability to deliver these specialized services. NAPT continues to maintain that reimbursement, regardless of site of service, must appropriately account for proton therapy’s substantial equipment investment, complex patient populations, specialized staffing, and clinical resources. Given the relatively low volume of proton therapy services, we believe further evaluation and collaboration are necessary to establish a sustainable, resource-based methodology. NAPT remains committed to working constructively with CMS, policymakers, and the proton therapy community to ensure reimbursement supports the long-term availability of proton therapy and protects patient access.
Read our executive summary of the MPFS final rule here.
