← Return to Prostatectomy vs Photon radiation vs Proton Beam Therapy

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@climateguy It is confusing that my RO stated that Medicare did not cover Proton and no advantage plans did either. I'm 76 with second biopsy showing Gleason 3+4 and PSMA-Pet scan showing small PC confined to prostate. I would like to know who is currently paying for Proton as we are in the time period for updating our medicare coverage to a plan that does cover it.

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Replies to "@climateguy It is confusing that my RO stated that Medicare did not cover Proton and no..."

@ketter1 Re: does Medicare over proton therapy? I haven't had proton therapy or attempted to get Medicare to pay for proton therapy so I don't know. Your RO could be correct, but it also seems to be correct to say Proton therapy can be covered by Medicare.

I found this on CMS.gov Search for the page using this term without the quotation marks: "LCD - Proton Beam Therapy (L35075)"

"PBT is considered reasonable in instances where sparing the surrounding normal tissue cannot be adequately achieved with photon-based radiotherapy and is of added clinical benefit to the patient."

Also: "Prostate Cancer: Coverage and payments of proton beam therapy for prostate cancer will require: Physician documentation of patient selection criteria (stage and other factors as represented in the NCCN guidelines);
Documentation and verification that the patient was informed of the range of therapy choices, including risks and benefits."