This bill, titled the "Radiation Oncology Case Rate Value Based Program Act of 2025," seeks to fundamentally reform how Medicare pays for radiation oncology services. It mandates the establishment of a new Radiation Oncology Case Rate Value Based Payment Program (ROCR Program) within one year of enactment, shifting from traditional fee-for-service to per-episode payments for covered treatments. The ROCR Program's primary goals include creating stable and unified payments, reducing disparities in care by increasing access, enhancing quality through practice accreditation, encouraging the use of state-of-the-art technology, and achieving reasonable spending reductions for Medicare. Payments will be made as 80 percent of a per-episode amount, with the first half paid prospectively and the second half upon completion or a specified timeframe, ensuring payment consistency regardless of the service site. National base rates for these per-episode payments will be determined based on 2021 M-Code rates and updated annually for inflation, with periodic rebasing every five years. These rates will be subject to various adjustments, including geographic, inflation, and a savings adjustment designed to achieve Medicare savings. New technologies will be incorporated into base rates after a 12-year exclusion period, with separate transitional payments for adaptive radiation therapy planning. A significant provision is the Health Equity Achievement in Radiation Therapy Add-On Payment , initially set at $500 per patient per episode, increasing annually. This add-on is triggered by a reported ICD-10 code for transportation insecurity and is intended to help patients access and complete their treatments by funding transportation services. Providers receiving this add-on must maintain documentation of its use for five years. The bill also introduces quality incentives , offering an initial payment increase for providers who meet accreditation and electronic health record (EHR) requirements. Conversely, after two years, non-compliant providers (excluding limited resource providers) will face a 2.5 percent payment reduction. Accreditation can be obtained from recognized organizations like the American College of Radiology or through external audits for limited resource providers. Furthermore, the legislation amends the Social Security Act to create a new statutory exception to civil monetary penalties, allowing eligible entities to provide free or discounted transportation services to radiation oncology patients. This exception comes with specific conditions, such as a uniform policy, no marketing by drivers, and limitations on patient eligibility based on established patient status and geographic proximity or rural residence. Crucially, the bill explicitly exempts any reduced expenditures resulting from the ROCR Program from being considered in Medicare's budget neutrality adjustments for both the physician fee schedule and hospital outpatient prospective payment system. This ensures that savings generated by the new payment model do not lead to cuts in other areas of Medicare. The Comptroller General is also tasked with reporting on the program's impact and identifying ways to improve access to radiation therapy in rural and underserved areas.