The CMS is considering reimbursing all Medicare providers for one-time cancer treatments that genetically alter patients' cells to fight the disease. The move could increase revenue by millions at each hospital offering the therapy.
CMS considers paying all Medicare providers for cancer gene therapies
While local Medicare contractors can cover CAR-T treatments already, there is no national payment policy to reimburse hospitals which typically administer the treatments. The CMS pays hospitals $500,839 for administering Kymriah and $395,380 for Yescarta. Hospitals also can secure more revenue from inpatient stays stemming from the treatment's side effects. The patient then also undergoes chemotherapy and if complications arise, might need to be hospitalized.
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