Medicare Coverage of Radiation Therapy
Medicare Part A covers radiation therapy provided to a hospital inpatient.
Medicare Part B covers radiation therapy provided to an outpatient in a hospital outpatient department or in a freestanding clinic or radiation treatment facility.
If radiation therapy is provided to a hospital inpatient, the cost becomes part of the overall hospital bill, which Medicare Part A pays according to the usual structure that requires a payment of a deductible, and coinsurance amounts for longer stays. Medicare Supplement plans can offset these gaps in coverage.
If radiation therapy is provided to an outpatient at a freestanding clinic or radiation treatment facility, Medicare Part B pays 80 percent of the Medicare-approved amount for the treatment. A Medicare Supplement would pay the other 20 percent.
If radiation therapy is provided at a hospital outpatient department, Medicare Part B pays the full Medicare-approved amount for the treatment, except for a patient co-payment or co-insurance.
Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C (Advantage) plan to provide coverage, the care must meet two basic requirements:
- The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper.
- The care must be performed or delivered by a healthcare provider who participates in Medicare.