Evaluating reimbursement of skin radiation therapy: Technique and fractionation

Multiple skin radiation therapy techniques exist including electron beam therapy, high-dose-rate (HDR) brachytherapy, superficial/orthovoltage, and electronic brachytherapy (EB). The purpose of this analysis was to compare reimbursement between these modalities by fractionation regimen.

Reimbursement was derived from the 2020 Medicare Physician Fee Schedule by fractionation schedule or from the 2020 Hospital Outpatient Prospective Payment national benchmarks. A secondary analysis evaluating incorporation of daily simulation codes was also performed to factor in coding heterogeneity.

Superficial/orthovoltage was the least costly and EB the next least costly technique regardless of fractionation. When incorporating variations in coding of simulations, reimbursement with superficial/orthovoltage was still least costly, with a reduction in cost of $1,755, $2,715, $5,076, and $7,436 compared with HDR brachytherapy for 6, 10, 20, and 30 fractions, respectively, and a reduction in cost of $1,325, $2,170, $4,281, and $6,392 compared with EB. HDR brachytherapy and EB costs can increase by 63-110% based on nonrecommended variation in daily simulation billing, with superficial/orthovoltage experiencing the highest relative increase. Reimbursement per course can vary by a factor of 4.5-9.3x depending on the modality and fractionation scheme utilized.

Superficial/orthovoltage followed by EB were the least costly modalities with regard to reimbursement; however, costs can vary with frequency of simulation code billing. Consistency and standardization in skin radiation therapy reimbursement is needed, and case rates within a radiation oncology alternative payment model may help to minimize reimbursement heterogeneity among treatment options.