American Shared Hospital Services announces 2015 CMS gamma knife and proton reimbursement rates

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American Shared Hospital Services has 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 as of 1 January, 2015, the Centers for Medicare and Medicaid Services has established a comprehensive ambulatory payment classification for both gamma knife and LINAC one session cranial radiosurgery. The reimbursement rate of approximately US$9,768 will be inclusive of the delivery and ancillary codes but exclusive of co-insurance payments or other adjustments. The average current Centers for Medicare and Medicaid Services reimbursement rate for delivery and ancillary codes (exclusive of co-insurance and other adjustments) is approximately US$5,600. This represents an estimated increase of US$4,168 per Medicare gamma knife treatment (exclusive of co-insurance and other adjustments) effective as of 1 January, 2015.

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

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