Mixed bag for radiotherapy reimbursements

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As a result of the announced Centers for Medicare and Medicaid Services (CMS) radiotherapy reimbursement rates changes, payment rises on average by three percent at hospitals but drops by around six percent at free-standing treatment centers, according to data released from an analysis by American Medical Accounting & Consulting (AMAC). The firm provides billing and practice management consulting services for oncology physicians, hospitals, freestanding facilities, universities and private practices throughout the United States.  

The new CMS reimbursement rules include new codes that for the first time support stereotactic radiosurgery with linear accelerators in freestanding centers. 

"For hospitals, reimbursement for some procedures will rise while others will decrease, but the net effect will be a slight increase," said James E. Hugh, III, MHA, CHBME, ROCC(R), senior vice president with AMAC, in a statement. "Typical hospital radiation oncology departments with an average patient load and modern equipment will see an increase of about three percent for their patients."

AMAC believes that average freestanding radiation oncology centers are likely to see a slight decrease in reimbursement rates. A freestanding center treating 360 patients per year with 37 percent of the patients receiving IMRT, for example, will see in the neighborhood of a six percent decrease in reimbursements, said Hugh.

"However, for the first time, freestanding centers will be able to bill for treating brain and spine lesions with stereotactic radiotherapy or radiosurgery, and for treating other types of lesions with stereotactic body radiosurgery," Hugh said. "This could support those clinics that want to expand their practices into this area."