Medicare proposes 30% lower reimbursement for freestanding proton therapy centers compared to hospitals
The Centers for Medicare and Medicaid Services has proposed a rule that would reimburse freestanding proton therapy centers nearly 30% less than hospitals for delivering the same treatment on the same equipment. Proton therapy is a precise form of radiation treatment available at roughly 50 centers across 28 states. The rule could be finalized this fall.
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A proposed Medicare reimbursement rule from the Centers for Medicare and Medicaid Services would pay freestanding proton therapy centers approximately 30% less than hospitals for identical proton treatments, according to the Washington Examiner, which published an opinion piece from Dr. Shannon MacDonald, medical director of the Southwest Florida Proton Center and a former Harvard Medical School associate professor.
Proton therapy delivers radiation with greater precision than standard X-ray therapy, reducing exposure to surrounding healthy tissue. Proponents say that precision is especially valuable for pediatric patients, whose developing organs sit close to tumors, and for adults with cancers near the spine, eye, or other sensitive structures. About 50 centers offer the treatment nationwide, spread across 28 states, leaving large regions — including the Great Plains, much of the Mountain West, and parts of the South — without access.
CMS has described the new pricing approach as an effort to make proton reimbursement more consistent across settings. Dr. MacDonald, writing in the Washington Examiner, argued that paying less for the same treatment based solely on the type of facility delivering it is "the opposite of consistency," and called on the agency to raise the freestanding rate to match the hospital rate rather than widen the existing gap.