Medicare Coverage of Radiation Therapy
What It Is
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 you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for radiation therapy, contact the plan directly.
What Medicare Pays
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 a structure that requires patient payment of a deductible, and patient payments of coinsurance amounts for longer stays.
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.
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.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C 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. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.