Does Medicare Cover Proton Beam Therapy

January 18 2008 change request 5790.

Does medicare cover proton beam therapy.

Coverage varies by insurance company and disease type. Cms national coverage policy. Proton beam therapy for prostate cancer. I talked to a medicare representative over the telephone today and she said proton beam therapy is not something typically covered.

The centers for medicare medicine services cms website has this to say about pbrt. Proton beam therapy. I would appreciate finding out if you or anyone you know has been approved for proton beam therapy by medicare. Oregon doesn t have a proton center.

As such insurance companies must also cover it. It can be used to treat many different types of cancers and medicare benefits often cover this treatment s costs. Medicare generally covers proton beam therapy. Payment insurance coverage options for proton therapy full coverage.

Rather it s in group two for which proton therapy is covered by medicare as long as certain special conditions are met. While proton beam cancer therapy treatment is covered by medicare private insurance coverage varies. We heard humana hmo may not cover the cost of proton treatment especially if it s outside of oregon. One of these options is known as proton therapy or proton beam therapy.

Md anderson proton therapy center accepts several major insurance plans as well as medicare and medicaid. We live in oregon and have medicare advantage with humana hmo insurance. If proton beam therapy is the treatment recommendation the center where you get care will help you identify if health insurance will cover you. National coverage determination ncd for routine costs in clinical trials 310 1 cms manual system pub 100 20 one time notification transmittal 310 date.

I have heard both medicare does not cover proton beam radiation therapy pbrt and medicare does cover pbrt. This includes any appeals process with the insurance company. For the most part medicare will cover proton beam therapy. But coverage will depend on the insurance company and the type of disease.

I talked to an md anderson representative over the telephone today and she said medicare has been paying for proton beam therapy at md anderson. After lots of research we are thinking about proton therapy in california or another state. The representative did not say proton beam therapy is not covered. Some companies do not reimburse for the service or only cover treatment for certain diagnoses.

Mayo clinic specialists work with each patient and the health insurance company to determine if proton beam therapy is covered if that is the recommended treatment. Contractor s determination number. What if i don t have insurance but want proton therapy. Proton therapy is covered in the united states by medicare and many insurance providers.

Our patient access specialists can work with your insurance carrier to define your benefits. This is a type of radiation therapy and it allows physicians to more specifically target cancerous tissue to prevent healthy tissue from being destroyed.