iCAD Responds to CMS’ Finalized Radiation Oncology Alternative Payment Model
IORT reimbursement unchanged; payment values for alternative, longer courses of radiation therapy reduced
NASHUA, N.H., Sept. 20, 2020 (GLOBE NEWSWIRE) -- iCAD, Inc. (NASDAQ: ICAD), a global medical technology leader providing innovative cancer detection and therapy solutions, is providing additional comments following the
Centers for Medicare & Medicaid Services’ (CMS) publication of a new Innovation Center model designed, according to CMS, to improve the quality of care for cancer patients receiving
radiotherapy and reduce Medicare expenditures through bundled payments. CMS indicated that the new Radiation Oncology (RO) Model allows this focus on value-based care by creating simpler, more
predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS,
is scheduled to be implemented on January 1, 2021.
The RO Model is intended to address payment differences and provide bundled payments during a 90-day episode of care to participating radiotherapy providers and suppliers furnishing radiotherapy for 16 different cancer types, including anal cancer, brain metastases, breast cancer, cervical cancer, colorectal cancer and prostate cancer.
The notice sets forth Medicare’s national base payment rates for the radiation oncology services subject to the new payment model that are provided during 90-day episodes of care, regardless of the treatment modality selected.
Under Medicare’s traditional fee-for-service payment system, the estimated reimbursement using Medicare’s 2020 national rates for treatment of breast cancer include the following:
- For intensity modulated radiation therapy (IMRT), payment values are approximately $3,147 for physicians and $23,213 for facilitiesi
- For external beam radiation therapy (EBRT), payment values are approximately $3,349 for physicians and $13,445 for facilitiesii
- For Xoft intraoperative radiation therapy (IORT), payment values are approximately $402 for physicians and $7,942 for facilities.iii
In 2021 the estimated reimbursement for the selected 30% of the country will include the following:
- For selected modalities (including IMRT and EBRT) under the RO Alternative Payment Model, payment values will be approximately $2,081 for physicians and $10,129 for
The Medicare proposed reimbursement for Xoft, which would apply to 100% of the market and is subject to final CMS approval, is $360 for physicians and $7,938 for facilities.