Palmetto GBA Freestanding Center Payment Rates Announcement Final

Palmetto Government Benefits Administrators (GBA)

Formalizes Freestanding Payment Policy for CyberKnife Robotic Radiosurgery
for Calendar Year 2011, Establishes Retroactive Payment Rates for Calendar Years
2009 and 2010, and Makes Improvements in Claims Processing for CyberKnife
Treatment of Prostate, Adrenal, and Brain Cancers
On February 24, 2011 the CyberKnife Coalition (CKC) announced, following constructive
meetings between the CKC and the Palmetto leadership, that Palmetto had revised its
freestanding payment policy for CyberKnife treatment delivery to be at parity with hospital
outpatient departments. We are pleased to announce that on March 8, 2011 Palmetto
formalized its new payment policy for 2011 and took an additional positive step to publish
payment rates for retroactive claims processing for freestanding centers who experienced
CyberKnife denials in calendar years 2009 and 2010. All rates have been adjusted to reflect slight fluctuations in the outpatient payment rates year on year.
The new and retroactive rates for CyberKnife freestanding treatment delivery can be found
in a special, stand-alone publication titled “Carrier Priced Fee Revisions for HCPCS Codes G0339 and G0340” on the Palmetto Website at:

Providers California, Nevada, and Hawaii select:
J1 Part B MAC – CA, NV, HI then Fee Schedules
Providers in South Carolina select:
South Carolina Part B Carrier then Fee Schedules
Providers in West Virginia select:
West Virginia Part B Carrier then Fee Schedules
Providers in Ohio select:
Ohio Part B Carrier then Fee Schedules
Palmetto will also establish payment at the outpatient rates for North Carolina and Virginia
once the transition of these states from the previous Part B Contractors has occurred; for
Virginia after March 19, 2011, and for North Carolina after May 28, 2011.
Finally, in an unrelated yet positive separate move, Palmetto released a publication on
March 4, 2011 for Jurisdiction 1, clarifying that it had made a mass adjustment to its
claims processing system and will pay for services that may have been denied in error
for CyberKnife treatment since it implemented its SRS and SBRT policies in March,
2009. Specifically Palmetto addresses the prostate diagnosis codes 185, 233.4, 236.5,
adrenal cancer diagnosis code 255.4, and malignant neoplasm of the brain diagnosis
code 191.6. This publication titled “J1 Stereotactic Body Radiation Therapy LCD and
Stereotactic Radiosurgery LCD Diagnosis Corrections” can also be found on the
Palmetto website.
Providers California, Nevada, and Hawaii select:
J1 Part B MAC – CA, NV, HI then Alerts
The CyberKnife Coalition appreciates these positive steps made by Palmetto to improve
patient access to this valuable and life-saving treatment option. We look forward to
keeping you involved as we continue our work with Palmetto and other Medicare
contractors on important issues affecting access to CyberKnife treatment.