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Medicaid Reimbursement for Breast Radiation Varies by State

WEDNESDAY, May 1, 2019 -- Coverage and payment rates for radiation oncology services under Medicaid vary considerably by state, according to a study published online March 31 in the International Journal of Radiation Oncology • Biology • Physics.

Ankit Agarwal, M.D., from the University of North Carolina at Chapel Hill, and colleagues analyzed the extent of variations in Medicaid reimbursements for radiation oncology services across the United States. Publicly available fee schedules were analyzed for Current Procedural Terminology codes billed for a course of hypofractionated whole breast radiation in 48 states and Washington, D.C.

The researchers found that the total episode reimbursement (excluding image guidance for respiratory tracking, which was paid for in just 21 states) varied from $2,945 to $15,218 (mean, $7,233; standard deviation, $2,248 or 31 percent). The correlation coefficient of the Kaiser Family Foundation Medicaid-to-Medicare fee index to the calculated entire episode of care for each state was 0.55, which suggests greater differences in reimbursements in radiation oncology compared with medical services generally.

"Greater stability and fairness in Medicaid compensation would help stabilize access for Medicaid patients and make it more financially feasible for the physicians who care for them, especially in rural communities and those with fewer physicians overall," Agarwal said in a statement.

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Posted: May 2019

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