A proposed rule issued on July 8 by the U.S. Centers for Medicare and Medicaid Services (CMS) would settle a reimbursement spat between radiation therapy firm Varian Medical Systems and Swedish company Elekta.
The kerfuffle began last November, when CMS' final HOPPS rule for 2013 set reimbursement rates of more than $7,000 for Elekta's radiosurgical device, Gamma Knife, while reimbursement for Varian's linear accelerator-based stereotactic radiosurgery systems was $3,500.
In January, a last-minute provision in the congressional budget bill that addressed the U.S. "fiscal cliff" -- put through by Senate Majority Leader Harry Reid (D-NV) -- mandated that Medicare payments for a treatment with Varian's system remain the same, but for hospitals using Elekta's Gamma Knife reimbursement would be reduced 58% -- bringing payments for the two devices roughly to par.
CMS' proposed rule for 2014 would override this provision and make reimbursement to facilities performing brain tumor radiosurgery in a single treatment the same amount -- $8,576 -- whether clinicians use Gamma Knife or Varian's system. Multiple treatments would be reimbursed at a rate of $2,480 each, according to the proposed rule.
