§ 512.230 - Criteria for determining cancer types.

§ 512.230 Criteria for determining cancer types.

Cross Reference

Link to an amendment published at 86 FR 63996, Nov. 16, 2021.

(a) Included cancer types. CMS includes in the RO Model test cancer types that satisfy all of the following criteria. The cancer type:

(1) Is The cancer type is commonly treated with radiation ; and per nationally recognized, evidence-based clinical treatment guidelines;

(2) Has The cancer type has one or more associated current ICD-10 codes that have demonstrated pricing stability; and

(3) The Secretary has not determined that the cancer type is not suitable for inclusion in the RO Model.

(b) Removing cancer types. CMS removes cancer types in the RO Model if it determines:

(1) RT is no longer appropriate to treat a cancer type per nationally recognized, evidence-based clinical treatment guidelines;

(2) CMS discovers a

That there is a ≥10 percent error in established national base rates; or

(

3

2) The

Secretary determines a

cancer type

not to be suitable for inclusion in the RO Model

does not meet the criteria set forth in paragraph (a) of this section.

(c) ICD-10 codes for included cancer types. CMS displays on the RO Model website no later than 30 days prior to each PY the ICD-10 diagnosis codes associated with each included cancer type.

[85 FR 61362, Sept. 29, 2020, as amended at 86 FR 63996, Nov. 16, 2021]