Ron DiGiaimo

linkedin.com/pulse/guide-yo… Please check out this article meant to help #RTTs in their first five years. @OfficialRCCSInc @ASRT @RegentsHealth #radiationtherapy

I’ve been swamped since I’ve returned from @oncologyCOA the Annual 2026 Community Oncology Alliance meeting. It was great 👍🏻. Excellent presentations, attendance and discussion. Also great to catch up with so many old and new friends. @OfficialRCCSInc

@GavinNewsom What about all the FRAUD under YOUR WATCH????

Fox News lies. We sued. A judge sided with us in an initial decision. Discovery will be fun!!!

Wow so cool 😎

Why are supportng the Stop Nick Shirley act to try and hide the FRAUD you enabled??? Are YOU benefiting from the FRAUD???? Appears so from donations????? Have you identified and supported the FRAUD being uncovered all over CA??? Are you so dense you could not see the nonsense and abuse of the. High speed train or are you part of the FRAUD?

A complete WASTE of taxpayer dollars. Pete Hegseth and Kid Rock need to be INVESTIGATED NOW! While Trump is ripping health care away, how much did this crap cost us???

@GovPressOffice They are suffering g from THE FRAUD you enabled and refuse to support identifing with independent journalists like Nick Shirley. Instead you and your team are trying to create laws making it more difficult to identify and combat FRAUD!!! Why is that???

To those suffering from California Derangement Syndrome — this one’s for you!

@GavinNewsom Why are you trying to make laws to hide FRAUD identification lime the Stop Nick Shirley act? Pathetic, are you benefiting from FRAUD? Is that why you are ignoring the HUGE AMOUNTS OF FRAUD Bri g identified all over CA??

The Trump administration is pulling off the greatest grift we’ve seen in our lifetime.

Morning 👋🏻, Yes major declines for sure, but to be fair, the referenced payer is CA Medi-cal that state’s Medicaid…. They are still unacceptably low rates…. But also the worst payer in our specialty of Rad Onc… worse even is MA medicine which lists the treatment codes as I.C. Meaning independent contractor. Each clinic/Dr has to be evaluated to IF they will be reimbursed and if so, how much they will pay so unless you are familiar with that status code and aware Jan 1 of that stays, you don’t know to reach out to negotiate until you are not receiving payment….. TX does not list the treat codes as payable, but allows for pro tech and global reimbursement of 77387, (giving benefit of the doubt maybe they allowed for proton tx delivery non-bundling, haha) but “promises” (not in writing) to make the payments right to Drs and clinics for treatment payment correction, but “it may takes MONTHS FOR correction”!!! NM has unacceptably low treatment rates for 407 & 412 and same for VA …. Each state literally requires a review…..so many!

Can plausibly argue that in some regions of the country and in some payor scenarios the reimbursement for IMRT (our primary tool) in #radonc has fallen by *** ~95% *** over the last 20 years Again, that simply won't be compatible with rad onc continuing on as a specialty

The Annual Community Oncology Alliance Conference 2026 was awesome 👏🏻. I’ve been trying to go for years but have always had conflicting meetings or client responsibilities. If you have not been I’d encourage you to check it out. This is an unexpected break out of song to encourage political support for changes to oncology reimbursement both medical and radiation. Loved it 🙌🏻 “FIGHT” @OfficialRCCSInc @oncologyCOA #medonc #radonc

Attention Radiation Oncology in CA. We have been working on nationwide issues since January but we need help in Numbers to get further traction. The current response of, "it will be addressed in 2027" is NOT going to be helpful to many locations and truly puts access at risk for the most vulnerable population of patients. There is no single national payment average for Medicaid as the program is state specific. That said, there are MANY opportunities across the nation for involvement and awareness.  •CA – Medi-Cal which adjudicates Medicaid claims for payment in California as an example •The codes in question are –77387 – Currently recognizing $0 for payment to the Radiation Oncologist for IGRT services –77402 – Currently recognizing $42.40 –77407 – Currently recognizing $38.77 –77412 – Currently recognizing $43.20The codes in question are •By comparison, national Medicare benchmarks for these same services (updated effective January 1, 2026, under the revised CPT coding structure that bundles technical image guidance into the delivery codes) are substantially higher and reflect the true resources involved:  • CPT 77387 (professional component only): approximately $36.74 (Medicare PFS non-facility; commercial payers often reimburse $100–$130). • CPT 77402 (Level 1): approximately $79.49 (PFS non-facility) to $104.24 (HOPPS). • CPT 77407 (Level 2): approximately $317.64 (PFS non-facility) to $394.05 (HOPPS). • CPT 77412 (Level 3): approximately $391.46 (PFS non-facility) to $564.51 (HOPPS). Write to your local representative and get engaged. Contact me directly, if you want help with a letter or phone number to call. ron.digiaimo@rccsinc.com or my cell at 512-971-7724 text is best. thanks Ron RCCS R3source Health: RCCS | Regents | RC Billing

TEXAS MEDICAID ISSUES in RAD ONC: 77387, 77402, 77407, 77412 Medicaid Payment Rate Examples TX As per the Current Medicaid Payment Fee for Texas Medicaid. Notice they are still listing Pro/Tech and Global for the IGRT service of CPT code 77387. Such major discrepancies from CA, not illustrate state by state differences in Payment but also type of service. This requires Local knowledge and advocacy on top of national knowledge and advocacy. Hospitals at contracted rate. Physicians in TX for Radiation Therapy Centers lists Not Payable and not listed for Treatment Delivery of 77402, 77407 and 77412! “Perhaps” there is In this .68 RVU for IGRT Professional of IGRT 77387. Yet payment rates currently published list all. Again, perhaps it is specific to Proton, but there is no written description and requires the sophistication of the reader to cross reference CPT and other Authoritative Guidance. •Type of Service for Medicaid Payment Rates in TX Effective Rate 1/1/26 –TOS – 6 = Radiation Ther Global/Total Service = $59.61 –TOS - I – Pro Component (Modifier 26) = $16.31 –TOS – T – Technical Component (Modifier TC) = $43.30 •Type of Service for Medicaid Payment Rates in TX as of 3/1/26 –TOS – 6 = Rad Therapy Global/Total Service = $60.68 –TOS - I – Pro Component (Modifier 26) = $16.57 –TOS – T – Technical Component (Modifier TC) = $44.11 This is just another example of how the new codes have discrepancies in payers databases nationwide and how they need our help to correct. While we have been working on this, numbers and team involvement helps!!! If you would like assistance in a letter or phone number contact me directly via email at ron.digiaimo@rccsinc.com or cell text at 512-971-7724. thanks Ron @ASRT @OfficialRCCSInc @CancerExecs @CancerNetwrk @ACCCBuzz @ASTRO_org @oncologyCOA

Attention Radiation Oncology in MA: This is yet another example of Medicaid issues in another state we are addressing and need help with regarding Numbers and attention. Payment Rate Examples MA Medicaid As per the Current Medicaid Payment Fee for Massachusetts Medicaid. Physicians in MA for Radiation Therapy Centers lists I.C. (Individual Consideration) for Treatment Delivery of 77402, 77407 and 77412 and IGRT 77387. I.C. Listed. This means that each code and physician practice is evaluated on a case-by-case basis as to whether it is payable or not and what amount if any is set. “MA Health determines payment rate on a case-by-case basis after reviewing provider’s documentation of services rendered.” Unless you are aware and involved and make it an issue, there is a possibility this comes out as zero which is a problem access wise to this group of patient population likely needing care the most of any payer group. Evaluation criteria – Time required, Degree of Skill required, Severity or Complexity of Patient’s condition and relevant invoices or Operative Reports. @ASTRO_org @oncologyCOA @ASRT @CancerExecs @ACCCBuzz @Society_SROA

Ron DiGiaimo, MBA FACHE RCCS / RC Billing PO Box 429 Cedar Park, TX 78630 ron.digiaimo@rccsinc.com 512-971-7724 4/30/26 Timothy Offord Commissioner State of Alabama, Alabama Medicaid Agency PO Box 5624 Montgomery, AL 36103-5624 Timothy.Offord@medicaid.alabama.gov Re: Urgent Request to Update and Correct Alabama Medicaid Payment Rates for Radiation Oncology Services – CPT Codes 77387, 77402, 77407, and 77412 Dear Alabama Medicaid Agency Commissioner: I am writing to you in my capacity as Chairman of R3 and CEO of RC Billing with clients in Alabama to express grave concern regarding the current Alabama Medicaid reimbursement rates for essential radiation oncology treatment delivery and guidance services. These outdated rates are unsustainable, severely undermine the financial viability of providing high-quality radiation therapy, and place timely access to care at serious risk for Medicaid beneficiaries who require this life-saving treatment for cancer if these facilities are forced to halt services. Specifically, Alabama Medicaid currently provides $24.07 reimbursement for CPT code 77387 (Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking when performed – now representing the professional component following 2026 coding updates). The rates for the revised radiation treatment delivery codes are as follows: • CPT 77402 (Radiation treatment delivery, Level 1): $50.18 • CPT 77407 (Radiation treatment delivery, Level 2): $189.42 • CPT 77412 (Radiation treatment delivery, Level 3): $272.53 • CPT 77387 (Image Guidance Rad Therapy): $24.07 These rates are catastrophically low and do not come close to covering the actual costs of delivering safe, precise, and effective radiation therapy. Radiation oncology requires substantial capital investment in linear accelerators, imaging systems, quality assurance, physics support, and highly trained clinical staff. At these reimbursement levels, practices cannot absorb the ongoing operational expenses, leading to reduced capacity, delayed treatments, or complete discontinuation of services for Alabama Medicaid patients in many communities. This directly jeopardizes patient outcomes in a vulnerable population that already faces barriers to care. By comparison, national Medicare benchmarks for these same services (updated effective January 1, 2026, under the revised CPT coding structure that bundles technical image guidance into the delivery codes) are substantially higher and reflect the true resources involved: • CPT 77387 (professional component only IGRT): approximately $36.74 (Medicare PFS non-facility; commercial payers often reimburse $100–$130). • CPT 77402 (Level 1): approximately $79.49 (PFS non-facility) to $104.24 (HOPPS). • CPT 77407 (Level 2): approximately $317.64 (PFS non-facility) to $394.05 (HOPPS). • CPT 77412 (Level 3): approximately $391.46 (PFS non-facility) to $564.51 (HOPPS). Alabama Medicaid’s rates are materially lower than Medicare’s rates, which are they themselves below costs in many instances, creating an untenable disparity. Many commercial payers reimburse at even higher levels but not always available at necessary ratios. These national rates, while not extravagant, at least allow practices to maintain operations and invest in modern technology required for accurate, image-guided treatment. The situation is urgent. Radiation therapy is a cornerstone of curative and palliative cancer care in which approximately 60% of cancer patients receive radiation therapy at some point in their treatment journey. Inadequate reimbursement threatens provider participation in Alabama Medicaid networks, reduces geographic access (particularly in underserved areas), and risks poorer survival outcomes and increased downstream costs to the state from unmanaged disease progression. We respectfully request that your appropriate team immediately review and align Alabama Medicaid payment rates for CPT codes 77387, 77402, 77407, and 77412 with national Medicare benchmarks (or a reasonable cost-based equivalent) to ensure continued access to these critical services. We are available to provide additional data, cost analyses, or meet with your team to discuss this matter promptly. Thank you for your immediate attention to this critical patient-access issue. We look forward to your response and collaborative action to protect Alabama Medicaid beneficiaries’ access to radiation oncology care. Sincerely, Ron DiGiaimo MBA FACHE Chairman of R3 and CEO of RC Billing ron.digiaimo@rccsinc.com @OfficialRCCSInc

Yes!!!

FYI IMPORTANT updates in this chain and other posts regarding numerous other states.

Attn Virginia Radiation Oncology Providers with Medicaid Patients: Ron DiGiaimo, MBA FACHE RCCS / RC Billing PO Box 429 Cedar Park, TX 78630 ron.digiaimo@rccsinc.com 512-971-7724 5/1/26 Steve Ford Director Virginia Medicaid Virginia Department of Medical Assistance Services 600 East Broad Street Richmond, Virginia 23219 Re: Urgent Request to Update and Correct Medicaid Payment Rates for Radiation Oncology Services – CPT Codes 77407, and 77412 Dear Director of Virginia Medicaid: I am writing to you in my capacity as Chairman of R3 and CEO of RC Billing with clients in Virginia to express grave concern regarding the current Virginia reimbursement rates for essential radiation oncology treatment delivery and guidance services. These outdated rates are unsustainable, severely undermine the financial viability of providing high-quality radiation therapy, and place timely access to care at serious risk for Virginia beneficiaries who require this life-saving treatment for cancer if these facilities are forced to halt services. The rates for the “revised” radiation treatment delivery codes are as follows: • CPT 77407 (Radiation treatment delivery, Level 2): $219.55 (effective dates 2014 - 9999) • CPT 77412 (Radiation treatment delivery, Level 3): $208.42 (effective dates 2014 - 9999) These rates are low and do not come close to covering the actual costs of delivering safe, precise, and effective radiation therapy, nor are they reflective of 2026 description of service, which is not the same as the historical descriptions of these previously used codes that were re-activated. Radiation oncology requires substantial capital investment in linear accelerators, imaging systems, quality assurance, physics support, and highly trained clinical staff. At these reimbursement levels, practices cannot absorb the ongoing operational expenses, leading to reduced capacity, delayed treatments, or complete discontinuation of services for Virginia patients in many communities. This directly jeopardizes patient outcomes in a vulnerable population that already faces barriers to care. By comparison, national Medicare benchmarks for these same services (updated effective January 1, 2026, under the revised CPT coding structure that bundles technical image guidance into the delivery codes) are substantially higher and reflect the true resources involved: • CPT 77407 (Level 2): approximately $317.64 (PFS non-facility) to $394.05 (HOPPS). • CPT 77412 (Level 3): approximately $391.46 (PFS non-facility) to $564.51 (HOPPS). Virginia rates are significantly lower than Medicare’s, creating an untenable disparity. These national rates, while not extravagant, at least allow practices to maintain operations and invest in modern technology required for accurate, image-guided treatment. The situation is urgent. Radiation therapy is a cornerstone of curative and palliative cancer care in which approximately 60% of cancer patients receive radiation therapy at some point in their treatment journey. Inadequate reimbursement threatens provider participation in Virginia networks, reduces geographic access (particularly in underserved areas), and risks poorer survival outcomes and increased downstream costs to the state from unmanaged disease progression. We respectfully request that your appropriate team immediately review and align Virginia payment rates for CPT codes 77407, and 77412 with national Medicare benchmarks (or a reasonable cost-based equivalent) to ensure continued access to these critical services. We are available to provide additional data, cost analyses, or meet with your team to discuss this matter promptly. Thank you for your immediate attention to this critical patient-access issue. We look forward to your response and collaborative action to protect Virginia beneficiaries’ access to radiation oncology care. Sincerely, Ron DiGiaimo MBA FACHE Chairman of R3 and CEO of RC Billing ron.digiaimo@rccsinc.com #radonc @OfficialRCCSInc @ASRT @ASTRO_org @ACCCBuzz @CancerExecs @aamd_foundation @Society_SROA

New Mexico: Ron DiGiaimo, MBA FACHE RCCS / RC Billing PO Box 429 Cedar Park, TX 78630 ron.digiaimo@rccsinc.com 512-971-7724 4/30/26 Alanna Dancis Interim Medicaid Director New Mexico Human Services Department New Mexico Health Care Authority PO Box 2348 Santa Fe, New Mexico 87504-2348 alanna.dancis@hca.nm.gov Re: Urgent Request to Update and Correct Medicaid Payment Rates for Radiation Oncology Services – CPT Codes 77387, 77407, and 77412 Dear Medicaid Director: I am writing to you in my capacity as Chairman of R3 and CEO of RC Billing with clients in New Mexico to express grave concern regarding the current New Mexico reimbursement rates for essential radiation oncology treatment delivery and guidance services. These outdated rates are unsustainable, severely undermine the financial viability of providing high-quality radiation therapy, and place timely access to care at serious risk for New Mexico beneficiaries who require this life-saving treatment for cancer if these facilities are forced to halt services. Specifically, New Mexico currently provides $0 reimbursement for CPT code 77387 (Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking when performed – now representing the professional component following 2026 coding updates). The rates for the revised radiation treatment delivery codes are as follows: • CPT 77407 (Radiation treatment delivery, Level 2): $92.24 • CPT 77412 (Radiation treatment delivery, Level 3): $102.63 • CPT 77387 (IGRT): $0 These rates are catastrophically low and do not come close to covering the actual costs of delivering safe, precise, and effective radiation therapy. Radiation oncology requires substantial capital investment in linear accelerators, imaging systems, quality assurance, physics support, and highly trained clinical staff. At these reimbursement levels, practices cannot absorb the ongoing operational expenses, leading to reduced capacity, delayed treatments, or complete discontinuation of services for New Mexico patients in many communities. This directly jeopardizes patient outcomes in a vulnerable population that already faces barriers to care. By comparison, national Medicare benchmarks for these same services (updated effective January 1, 2026, under the revised CPT coding structure that bundles technical image guidance into the delivery codes) are substantially higher and reflect the true resources involved: • CPT 77387 (professional component only): approximately $36.74 (Medicare PFS non-facility; commercial payers often reimburse $100–$130). • CPT 77407 (Level 2): approximately $317.64 (PFS non-facility) to $394.05 (HOPPS). • CPT 77412 (Level 3): approximately $391.46 (PFS non-facility) to $564.51 (HOPPS). New Mexico’s rates are materially lower than Medicare’s (or zero in the case of 77387), creating an untenable disparity. Many commercial payers reimburse at even higher levels. These national rates, while not extravagant, at least allow practices to maintain operations and invest in modern technology required for accurate, image-guided treatment. The situation is urgent. Radiation therapy is a cornerstone of curative and palliative cancer care in which approximately 60% of cancer patients receive radiation therapy at some point in their treatment journey. Inadequate reimbursement threatens provider participation in New Mexico networks, reduces geographic access (particularly in underserved areas), and risks poorer survival outcomes and increased downstream costs to the state from unmanaged disease progression. We respectfully request that your appropriate team immediately review and align New Mexico payment rates for CPT codes 77387, 77407, and 77412 with national Medicare benchmarks (or a reasonable cost-based equivalent) to ensure continued access to these critical services. We are available to provide additional data, cost analyses, or meet with your team to discuss this matter promptly. Thank you for your immediate attention to this critical patient-access issue. We look forward to your response and collaborative action to protect New Mexico beneficiaries’ access to radiation oncology care. Sincerely, Ron DiGiaimo MBA FACHE Chairman of R3 and CEO of RC Billing ron.digiaimo@rccsinc.com

Florida Rad Onc Medicaid: Ron DiGiaimo, MBA FACHE RCCS / RC Billing PO Box 429 Cedar Park, TX 78630 ron.digiaimo@rccsinc.com 512-971-7724 4/30/26 Brian Meyer Deputy Secretary for Medicaid Florida Agency for Health Care Administration 2727 Mahan Drive, Mail Stop 8 Tallahassee, FL 32308 Brian.Meyer@ahca.myflorida.com Re: Urgent Request to Update and Correct Medicaid Payment Rates for Radiation Oncology Services – CPT Codes 77387, 77407, and 77412 Dear Deputy Secretary for Medicaid: I am writing to you in my capacity as Chairman of R3 and CEO of RC Billing with clients in Florida to express grave concern regarding the current Florida reimbursement rates for essential radiation oncology treatment delivery and guidance services. These outdated rates are unsustainable, severely undermine the financial viability of providing high-quality radiation therapy, and place timely access to care at serious risk for Florida beneficiaries who require this life-saving treatment for cancer if these facilities are forced to halt services. Specifically, Florida currently provides reimbursement at the rate of $46.17 FSI, PCI $12.19, TCI $33.89 for CPT code 77387 (Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking when performed – now representing the professional component following 2026 coding updates). The rates for the revised radiation treatment delivery codes are as follows: • CPT 77407 (Rad treatment delivery, Level 2): $149 • CPT 77412 (Rad treatment delivery, Level 3): $158.42 • CPT 77387 (IGRT): PC $12.19 These rates are catastrophically low and do not come close to covering the actual costs of delivering safe, precise, and effective radiation therapy. Radiation oncology requires substantial capital investment in linear accelerators, imaging systems, quality assurance, physics support, and highly trained clinical staff. At these reimbursement levels, practices cannot absorb the ongoing operational expenses, leading to reduced capacity, delayed treatments, or complete discontinuation of services for Florida patients in many communities. This directly jeopardizes patient outcomes in a vulnerable population that already faces barriers to care. By comparison, national Medicare benchmarks for these same services (updated effective January 1, 2026, under the revised CPT coding structure that bundles technical image guidance into the delivery codes) are substantially higher and reflect the true resources involved: • CPT 77387 (pro component only): approx$36.74 • CPT 77407 (Level 2): approx $317.64 • CPT 77412 (Level 3): approx $391.46 Florida’s rates are materially lower than Medicare’s (or zero in the case of 77387), creating an untenable disparity. These national rates, while not extravagant, at least allow practices to maintain operations and invest in modern technology required for accurate, image-guided treatment. The situation is urgent. Radiation therapy is a cornerstone of curative and palliative cancer care in which approximately 60% of cancer patients receive radiation therapy at some point in their treatment journey. Inadequate reimbursement threatens provider participation in Florida networks, reduces geographic access (particularly in underserved areas), and risks poorer survival outcomes and increased downstream costs to the state from unmanaged disease progression. We respectfully request that your appropriate team immediately review and align Florida payment rates for CPT codes 77387, 77407, and 77412 with national Medicare benchmarks (or a reasonable cost-based equivalent) to ensure continued access to these critical services. We are available to provide additional data, cost analyses, or meet with your team to discuss this matter promptly. Thank you for your immediate attention to this critical patient-access issue. We look forward to your response and collaborative action to protect Florida beneficiaries’ access to radiation oncology care. Sincerely, Ron DiGiaimo MBA FACHE Chairman of R3 and CEO of RC Billing ron.digiaimo@rccsinc.com @OfficialRCCSInc @ASRT @OneOncology @CancerExecs @Society_SROA @ASTRO_org @ACROSeals @AONOncology @TheUSONetwork

@SenWarren Nah YOU stopped the merger! You’re a business killer.

Spiking fuel prices from Trump’s war was the nail in the coffin for twice-bankrupted Spirit airline. FWIW, JetBlue merger failed because a judge, appointed by Ronald Reagan, said the deal was illegal. Republicans are desperate to shift blame from higher costs hitting families.

Vepdegestrant (PROTAC ER degrader) @US_FDA ✅ for HR+ metastatic breast based off #Veritac2 Ph III vs. (Fulvestrant) after CDK4/6i + AI: - mPFS 5.0 vs 2.1 mos in ESR1m (HR=0.57) - OS is immature - Well-tolerated, low discontinuation #bcsm @OncUpdates @OncoAlert