GroundRules
42 CFR 512.230: Criteria for determining cancer types.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER H—HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS
- PART 512—STANDARD PROVISIONS FOR MANDATORY INNOVATION CENTER MODELS AND SPECIFIC PROVISIONS FOR CERTAIN MODELS
- Subpart B—Radiation Oncology Model
(a) Included cancer types. CMS includes in the RO Model cancer types that satisfy the following criteria:
(1) The cancer type is commonly treated with radiation per nationally recognized, evidence-based clinical treatment guidelines;
(2) 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) That there is a ≥10 percent error in established national base rates; or
(2) The cancer type 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.
Collected 2026-08-27T02:26:11Z. Source file · JSON