3143 - Geographical Comparison of Medicare & Medicaid Services (CMS) Standard Charges for Complex Proton Therapy

K. R. Cargill¹, N. M. Feder¹, T. J. Wilhite¹, H. D. Skinner², Y. M. Mowery¹, and C. T. Wilke²; ¹Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, ²Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA

Purpose/Objective(s): Proton therapy is an expensive cancer treatment offered by 44 proton therapy centers in the United States (US). More than half of the operational centers are in the eastern US, leaving many individuals with limited access to this technology. We hypothesized that proton center location would influence prices, such that centers located in close proximity to one another would have lower, more competitive pricing compared to those that are geographically isolated. Materials/

Methods: We collected publicly available charge data from the 44 proton therapy centers operating in the US. We used CPT code 77525 (per fraction technical charge billed for complex proton treatment delivery) to extract the gross price, minimum and maximum price, median negotiated price from third-party payers, and cash price for treatment delivery. Centers were grouped using the US Census Bureau definition for Northeastern, Southern, Midwestern and Western locales. Price comparisons were performed using Kruskal-Wallis and Tukey’s multiple comparison tests with p-value <0.05 considered significant.
Results: Out of 44 operating proton therapy centers, 5 (11.4%) are free-standing private practice centers not affiliated with a hospital system, and thus not required to publish standard charge files per the 2021 CMS policy. Of the remaining 39 centers with publicly available charge data, 7 are in the Northeast, 17 in the South, 10 in the Midwest, and 5 in the West. 20 (51.2%) of the 39 centers were compliant with CMS requirements and had publicly available standard charge files. Among these centers with available data, 6 are located in the Northeast, 6 in the South, 6 in the Midwest, and 2 in the West. The median gross charge, minimum negotiated price, maximum negotiated price, negotiated price, and discounted cash price based on geographic location are outlined in Table 1. Only gross charge differed significantly based on US region, with the highest charges in the Northeast and West compared to the South and Midwest. Maximum negotiated price was higher in the Northeast and West, while minimum negotiated price, median negotiated price, and cash price were highest in the West.
Conclusion: Surprisingly, only half of operational US proton therapy centers are compliant with the 2021 CMS price transparency policy and provide publicly available standard charge data. Of those compliant centers, the data demonstrates geographic heterogeneity in proton therapy charges. Centers in the Northeastern US have a higher gross charge, while Western centers were noted to have higher minimum, maximum and median negotiated charges from third-party payers. Abstract 3143 – Table 1

US Region	Gross Charge	Minimum Negotiated	Maximum Negotiated	Median Negotiated	Cash Price
Northeast (n=6)	$12,863	$810	$10,254	$3,043	$3,664
South (n=6)	$5,709	$1,186	$5,554	$2,605	$3,763
Midwest (n=6)	$5,814	$1,902	$5,426	$2,217	$4,505
West (n=6)	$10,750	$3,208	$12,600	$6,244	$8,352
p-value	0.0465	0.2173	0.1982	0.4123	0.2306