Radiation therapy bills explained

Radiation therapy often means treatment most weekdays for several weeks. The bills can come just as often. Some charges appear once, some for every session, and some once a week.

This guide explains each charge and how to check the count. It's part of our guide to cancer treatment bills. If you also get infusions, see our guide to your chemotherapy bill. For help with drug costs, see help paying for cancer drugs.

What's on a radiation therapy bill?

Radiation therapy has a few stages. Each one brings its own charges.

Planning and simulation

Planning happens before your first treatment. Your team maps the area to treat and decides the dose. They may make a mask or mold so you lie the same way each time. If your plan changes during treatment, some planning may be billed again.

With a type of treatment called intensity-modulated radiation therapy (IMRT), the planning charge includes the simulation's field settings. Medicare's coding rules say those shouldn't be billed again on their own.

Treatment and image guidance

The center bills for each treatment session. Image guidance uses scans or X-rays to aim the beam. For some treatment types, it's part of the session charge. For others, it's billed as its own line.

Your doctor's weekly care

Your radiation oncologist bills for managing your treatment. Medicare counts this once for every 5 sessions, whatever the calendar says. Routine visits with your radiation oncologist during treatment are usually included.

Under Medicare's rules, routine follow-up care for 90 days after your last treatment is also part of this charge. So is checking your charts, reviewing your dose, and managing side effects.

Facility and professional charges

If you get radiation at a hospital, the hospital bills for the equipment, staff, and space. That's the facility or technical part. Your doctor bills for their work, which is the professional part. A freestanding center may send just 1 bill. Our guide to facility fees on a medical bill explains the difference.

How the weekly count works

Medicare counts weekly treatment management by sessions, not calendar weeks. Here's the rule.

• Every 5 sessions count as 1 week.
• 3 or 4 extra sessions at the end count as 1 more week.
• 1 or 2 extra sessions at the end don't add a week.

Many private plans follow similar rules, but check with yours. Each physics check usually follows the same 5-session count.

Why this happens: common radiation bill problems

Most problems fall into a few groups.

• Weekly charges counted by calendar week. A course that runs longer because of holidays or breaks shouldn't add charges.
• A session billed that didn't happen. Missed or moved sessions may still appear on the bill.
• Visits billed on their own during treatment. Routine visits are usually part of the weekly charge.
• Simulation billed with an IMRT plan. For IMRT, the plan already includes the simulation's field settings.
• A missing or expired approval. Many plans need to approve radiation before it starts. If your plan approves fewer sessions or a different type, your doctor can ask for more. See prior authorization denied.
• An out-of-network doctor at an in-network hospital. Federal law usually limits what they can bill you. See whether the No Surprises Act applies.

What to do: check your radiation therapy bill

1. Keep a treatment calendar. Write down each session date, or ask the center for a printed list.
2. Ask for an itemized bill. It should list each charge with its date. See how to get an itemized bill.
3. Count the sessions. The number of treatment charges should match your calendar.
4. Count the weekly charges. Use the table above to check your doctor's weekly management charges.
5. Look for extra visits. Ask about any routine office visit billed during treatment.
6. Match each bill to your explanation of benefits (EOB). Your amount due shouldn't be more than your share on the EOB for in-network care. Our guide to comparing a medical bill and an EOB shows how.
7. Call the billing office. Ask them to correct any error, send a corrected claim, and hold your account while they check.

Say Andre has Original Medicare and has already met his Part B deductible. He gets 28 radiation sessions over 7 calendar weeks, because of a holiday break. His calendar shows 28 sessions.

His bills show 29 treatment sessions at $500 each, and 7 weekly management charges at $200 each. Under Medicare's count, 28 sessions means 6 weekly charges.

Charge	Billed	Should be	Difference
Treatment sessions	29 × $500 = $14,500	28 × $500 = $14,000	$500
Weekly management	7 × $200 = $1,400	6 × $200 = $1,200	$200
Total	$15,900	$15,200	$700

Andre's share is 20%. The extra charges added 20% of $700, or $140, to what he owes. He calls the billing office with his calendar and asks for a corrected claim.

When to get help

You can often fix a count error with 1 call. It's worth getting help when:

• The provider won't correct a bill that doesn't match your calendar or your EOB.
• Your plan denied radiation therapy or approved fewer sessions than your doctor ordered. Our prior authorization appeal letter is a place to start.
• An out-of-network bill looks like one the No Surprises Act should have stopped.

Start with your insurer's member services number on your card. For Medicare, call 1-800-MEDICARE (1-800-633-4227), or get free counseling from your State Health Insurance Assistance Program. For surprise bills, call the No Surprises Help Desk at 1-800-985-3059.

Many cancer centers have a financial counselor who can help. Patient Advocate Foundation, a nonprofit, offers free case management for people with serious illness. A medical bill advocate can make the calls for you.