Medicare Coverage for Skin Cancer Radiation Therapy

Medicare Part B covers stereotactic radiotherapy (SRT) and other forms of radiation therapy for skin cancer, but only when a doctor orders it as medically necessary treatment. Medicare will not pay for the procedure if it is considered experimental, cosmetic, or performed at a facility that does not meet Medicare standards. The specific amount Medicare pays depends on where you receive treatment — a hospital outpatient department, an ambulatory surgery center, or a radiation oncology clinic — and whether you have supplemental coverage.

Skin cancer radiation therapy is most commonly used for basal cell carcinoma and squamous cell carcinoma when surgery is not an option or when the cancer is in a location where surgery would cause significant disfigurement. Medicare covers the planning, imaging, and treatment sessions themselves, though you will owe your coinsurance and deductible amounts.

Key Takeaways

  • Medicare Part B covers radiation therapy for skin cancer when a doctor determines it is medically necessary, not cosmetic or experimental.
  • You pay 20 percent coinsurance after you meet your Part B deductible, which is $240 per year in 2024.
  • The facility type — hospital, surgery center, or clinic — affects what Medicare pays and what you owe out of pocket.
  • Your radiation oncologist's office can contact Medicare to verify coverage before treatment begins, which prevents billing surprises later.

What Medicare Part B Actually Covers

Medicare Part B pays for radiation therapy when ordered by your doctor as treatment for a diagnosed skin cancer. This includes the initial consultation with the radiation oncologist, the planning session (called simulation), imaging scans used to map the treatment area, and each radiation therapy session. Medicare also covers the physicist's time in calculating the radiation dose and the technician's time in delivering the treatment.

What Medicare does not cover: cosmetic treatments (radiation used only to improve appearance), experimental procedures not yet approved by the FDA, or treatment at facilities that have not enrolled in Medicare. If your dermatologist or surgeon refers you to an out-of-network facility, you may face higher out-of-pocket costs or no coverage at all.

Your Out-of-Pocket Costs

After you meet your annual Part B deductible ($240 in 2024), Medicare pays 80 percent of the approved amount for radiation therapy. You pay the remaining 20 percent coinsurance. The total cost of a full course of skin cancer radiation therapy varies widely — from a few hundred dollars for a short course to several thousand dollars for more extensive treatment — so your 20 percent share depends on the length and complexity of your treatment plan.

If you have a Medigap supplemental policy, it may cover some or all of your coinsurance. If you have a Medicare Advantage plan (Part C), your out-of-pocket costs follow your plan's rules, which may include copays instead of coinsurance. Check your plan documents or call your plan's customer service number before your first appointment.

How to Verify Coverage Before Treatment Starts

The radiation oncology clinic or hospital where you will receive treatment can submit a coverage verification request to Medicare on your behalf. This is called a pre-authorization check or benefits inquiry, and it tells you before treatment begins whether Medicare will pay and what your estimated out-of-pocket cost will be. Ask your radiation oncologist's office to do this as soon as your treatment plan is finalized.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) and provide your Medicare number, your diagnosis code, and the procedure code your doctor plans to use. Have your insurance card and a list of your current diagnoses ready. Medicare will tell you whether the service is covered under your specific situation, though they cannot predict the exact dollar amount you will owe.

Differences Between Treatment Settings

Radiation therapy for skin cancer may be delivered at a hospital outpatient department, an independent radiation oncology clinic, or an ambulatory surgery center. Medicare pays the same 80/20 split at all three, but the total approved amount varies by setting. Hospital outpatient departments typically have higher approved amounts, which means both Medicare's payment and your coinsurance will be higher. Independent clinics often have lower approved amounts.

If your doctor recommends a specific facility, ask whether it is in-network with Medicare and whether your supplemental insurance (if you have it) covers treatment there. Some Medigap plans have network restrictions, though Medicare itself does not.

When Medicare May Deny Coverage

Medicare denies coverage for skin cancer radiation therapy in these situations: the procedure is deemed experimental or investigational; the facility is not Medicare-enrolled; the doctor's order does not document medical necessity; or the treatment is performed at an out-of-network facility when an in-network option was available. If Medicare denies your claim, the facility must send you a notice called an Explanation of Benefits (EOB) that explains the reason and tells you how to appeal.

You have the right to appeal any denial. The radiation oncology clinic can help you file an appeal, and many clinics have staff who handle Medicare disputes regularly. Do not ignore a denial notice — appeals must be filed within a specific timeframe, usually 120 days from the date on the notice.

Medicare Advantage Plans and Radiation Therapy

If you have a Medicare Advantage plan (Part C), your coverage for skin cancer radiation therapy is determined by your specific plan, not by Medicare Part B rules. Some plans cover radiation therapy with a copay; others require prior authorization; some may have network restrictions. Call your plan's member services number and ask whether radiation therapy for skin cancer is covered, what your copay or coinsurance will be, and whether you need prior authorization before scheduling treatment.

Medicare Advantage plans must cover at least what Original Medicare covers, but they can structure your costs differently. If your plan denies coverage that Original Medicare would pay for, you have the right to appeal through your plan and, if necessary, to Medicare itself.

Frequently Asked Questions

Does Medicare cover radiation therapy for melanoma?

Yes, Medicare Part B covers radiation therapy for melanoma when a doctor orders it as medically necessary treatment. Melanoma radiation therapy is less common than treatment for basal or squamous cell carcinoma, but Medicare covers it under the same rules — you pay 20 percent coinsurance after meeting your deductible.

What if my dermatologist says I need SRT but my insurance company says it is experimental?

SRT for skin cancer is not experimental — it is an FDA-approved treatment. If your plan denies it as experimental, ask your doctor to submit clinical evidence supporting the treatment, and file an appeal. Your radiation oncologist's office can provide peer-reviewed studies showing SRT is standard treatment for certain skin cancers.

Do I need a referral from my primary care doctor to see a radiation oncologist?

Medicare Part B does not require a referral for radiation therapy. You can see a radiation oncologist directly. However, your primary care doctor or dermatologist will need to provide your medical records and imaging so the radiation oncologist can plan your treatment.

Can I get radiation therapy at home or a clinic outside the United States?

Medicare does not cover radiation therapy performed outside the United States, except in very limited circumstances involving Canada and Mexico for emergency care. Radiation therapy must be delivered at a Medicare-enrolled facility in the United States for Medicare to pay.

What happens if I cannot afford my 20 percent coinsurance?

Talk to the radiation oncology clinic's financial counselor before treatment begins. Many clinics offer payment plans, and you may be able to work out a schedule that fits your budget. Some clinics also have information about local programs that help uninsured or underinsured patients with cancer treatment costs.