News | November 04, 2014

Final 2015 CMS Gamma Knife and Proton Reimbursement Rates Announced

Centers for Medicare and Medicaid Services establish Ambulatory Payment Classification for both treatments

Final 2015 CMS Gamma Knife and Proton Reimbursement Rates Announced

November 4, 2014 — American Shared Hospital Services announced that the Centers for Medicare and Medicaid Services (CMS) has posted its final Medicare hospital outpatient prospective payment rates for calendar year 2015. The rates for Gamma Knife and proton therapy remained as proposed earlier this year.

Effective Jan. 1, 2015, CMS has established a comprehensive Ambulatory Payment Classification (APC) for both Gamma Knife and LINAC one-session cranial radiosurgery. The comprehensive reimbursement rate of approximately $9,768 will be inclusive of the delivery and ancillary codes but exclusive of co-insurance payments or other adjustments. The average current CMS reimbursement rate for delivery and ancillary codes (exclusive of co-insurance and other adjustments) is approximately $5,600. This represents an estimated increase of $4,168 per Medicare Gamma Knife treatment (exclusive of co-insurance and other adjustments) effective Jan. 1, 2015.

Also, CMS’s final 2015 proton therapy delivery code rates per daily session are $515 ($872 in 2014) for a simple treatment without compensation, $1,056 ($872 in 2014) for a simple treatment with compensation, and $1,056 ($1,205 in 2014) for an intermediate or complex treatment.

For more information: www.ashs.com

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