Trends in Radiation Oncology Services in the IMRT Era: Evolving Patterns of Usage and Payments in Medicare Patients From 2000-2009

Reporter: Surbhi Grover, MD
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 4, 2011

Presenter: X Shen
Presenter Institution: Thomas Jefferson University, Philadelphia, PA


  • Use of IMRT has rapidly increased over the last decade for treatment of various cancers such as prostate and head and neck.
  • Also, there as has been an increase radiation oncology payments during the same time period.
  • Goal of this study was to look at radiation oncology practice and payment patterns over the last decade using medicare billing data.


  • Authors collected medicare data on radiation oncology utilization using billing codes for various radiation oncology modalities from 2000-2009. They also evaluated payments associated with these radiation oncology billing codes to look at payments for specific modalities.
  • Codes for the following modalities were included: external beam radiotherapy (EBRT), divided further into IMRT and non-IMRT, brachytherapy (BT), proton therapy (PT), stereotactic body radiotherapy (SBRT).
  • Temporal trends in utilization of radiation therapy using various modalities and the payments associated with them were calculated from 2000-2009.


  • From 2000-2009 there was moderate increase in utilization of radiation therapy overall. However, within in the EBRT modality, there was a substantial increase in use of IMRT such that in 2009, 51% of all EBRT treatments were done via IMRT vs 49% with non-IMRT modalities. This steep rise in IMRT was seen after 2002 when billing code for IMRT was introduced.
  • Although there are only moderate increases in utilization of radiation oncology, payment for radiation has increased from about $800 million in 2000 to $2 billion in 2009. IMRT accounts for majority of this increase in payment. The rate of increase was most significant between 2000-2007 (322%) and reduced significantly between 2007-2009 (4.4% between 2007-2008 and 1.4% between 2008-2009).
  • There has an increase in use of BT and PT as well, but they represent only a small portion of increase in total payment.
  • Also interesting to note is that in context to oncology as a whole, the four commonly used biologic agents together account for similar total payments as all of radiation oncology payments for 2009.


  • Increase in IMRT usage and IMRT payment accounts for a significant portion of increase radiation therapy payments. In it interesting in light of the fact that there is no randomized data for any cancer site that suggests that IMRT results in better clinical outcomes than non-IMRT treatments.
  • Payment of radiation oncology has increased significantly since 2000, but the rate of increase has plateaued in recent years.
  • There is no case specific data available here so we cannot predict which cancer sites have seen the most increase in use of IMRT.

Clinical and Scientific Implications

This study shows that the increase in payments to radiation oncology has been largely driven by IMRT. At the same time, there have been no prospective randomized studies showing superiority of IMRT over conventional treatment. It is a bit perplexing the radiation oncology community has criticized proton therapy for being an expensive treatment without randomized data without looking at the much larger use of IMRT. Oncology as a whole is high resource consuming specialty, and this study gives us a sense of the contribution of radiation oncology to that overall resource pie. Total medicare payment for all of radiation oncology in 2009 was similar to the total payment for four commonly used biologic agents.