One fraction SBRT listed at $9k. One fraction 3D-CRT listed at ~$1k. Even if you say 50% (likely an over-estimate) of that is based on fraction dosing (with the other 587 being cost of simulation, planning, etc.), 10 fractions would be $5500.
But exact price depends on a multitude of factors in the US. I have to imagine one-fraction SBRT is still at least 2x more expensive than 10fx 3D-CRT.
Might be outdated data. SBRT used to reimburse like this; prob doesn't anymore.
One fx 3DCRT of ~$1K makes zero sense as 77295 itself by its lonesome reimburses >$1000.
However, and DESPITE what some learned colleagues say around here, academic places I think have holdover rates with some private insurers where their SBRT reimbursement is very, very good.
I am sorry to ask, but what's the cost difference in the US between the 2 regiments?
What does 10 x 3 Gy, 3D-CRT cost and what does 1 fraction of SBRT cost (obviously IMRT/VMAT)?
1) Theoretically (see Evicore guidelines above) you can't get 3D paid for bone mets w/ private insurers.
2) For Medicare, you can get almost anything paid, including 5 fx SBRT if you want. (No pre-approval process you see; you bill it, they pay.)
3) You sure as hell will not get single-fx SBRT for a run-of-mill bone met paid for by private insurance.
4)
ACR says SBRT (and IMRT, which to me is how I'd plan an SBRT, there is no SBRT planning code in America, we bill the IMRT planning code usually, etc etc) is inappropriate for bony mets. I believe on basis of this study that might change.
4) This trial showed single-fx SBRT works, on a single met. Let's say we have a patient with multiple mets... I imagine some folks might try to do multi-fx SBRT on that, one SBRT per met. In America, we are limited to 5 fractions. Past that point, Cinderella's carriage becomes a pumpkin and the treatment magically becomes non-SBRT.
I would guess SBRT, global, is going to come in at about $5000 for single fraction. But for an MD just billing professional, he/she will come out about 60% ahead by converting from 10-fraction standard fx to SBRT, regardless of fractions. For an MD who gets tech and prof, and obviously for a hospital they get the tech, overall equal-to-better SBRT reimbursement especially if you start SBRT-ing multiple mets.
All the preceding is based on palliative, 10-fx or less scenarios.
One can see the large cut in reimbursement (and salary theoretically) American MDs paid on professional will endure in move to fewer fractions, or SBRT, as shown below, in curative type situations. Facilities will prob take cuts too.
www.ncbi.nlm.nih.gov
