Medicare Pay Cut Sparks Specialty Battle Over Skin Cancer Care
Key Insights
Five Republican members of Congress have urged CMS to reverse a roughly 75% Medicare payment cut for image-guided superficial radiation therapy (search) used in office-based skin cancer (search) treatment.
The payment cut, which took effect January 1, has led more than 160 dermatology practices to discontinue the therapy, potentially pushing rural patients toward less-accessible urban cancer centers.
The dispute highlights an ongoing conflict between dermatologists and radiation oncologists over appropriate use and reimbursement, with CMS and the AMA siding with radiation oncologists.
Five Republican members of Congress have formally pressed CMS Administrator Mehmet Oz, MD, and HHS Secretary Robert F. Kennedy Jr. to reverse a roughly 75% Medicare payment cut tied to image-guided superficial radiation therapy (search) (IGSRT), an office-based treatment for less serious skin cancer (search) types, Politico reported July 31.
Sens. Eric Schmitt of Missouri and Roger Marshall, MD, of Kansas, along with Reps. Ronny Jackson, MD, of Texas, and Brian Jack of Georgia, sent the initial letter in November urging CMS to delay the cut prior to its effective date of January 1. Rep. Carol Miller of West Virginia signed on in a follow-up letter sent the week of July 20.
"Preserving access to this lower-cost, office-based treatment option will help advance President Trump's goals of empowering patients, supporting independent medical practices, and improve healthcare quality and affordability for America's seniors," the most recent letter to Mr. Kennedy and Dr. Oz stated, according to Politico.
Broader Medicare Payment Context
The push to reverse the IGSRT payment cut comes as CMS proposed a rule on July 14 that would slash Medicare physician base rates for 2027 by up to 1.68%, to $32.84. This proposal is part of a larger overhaul of accountable care organization payments and a phaseout of the agency's decade-old MIPS quality-reporting program.
A Specialty-vs-Specialty Dispute
The controversy underscores an ongoing dispute between dermatologists who offer office-based image-guided radiation therapy and radiation oncologists over both Medicare reimbursement and the appropriate use of the treatment. CMS and the American Medical Association sided with the radiation oncologists during the rulemaking process.
"The cuts to superficial image-guided radiotherapy were extremely appropriate," Christopher Jahraus, MD, a radiation oncologist in Alabama, told the publication. Dr. Jahraus further stated that the radiation oncology codes to treat skin cancer (search) had been "inappropriately" used by dermatologists, leading to overspending by the government.
Impact on Patient Access
Kerwin Brandt, CEO of Burr Ridge, Ill.-based SkinCure Oncology (search), told Politico that more than 160 of the dermatology practices his company partners with nationally have ended the image-guided therapy since the pay cut went into effect. According to Brandt, this shift has pushed rural patients toward less-accessible urban cancer centers, raising concerns about care accessibility for Medicare beneficiaries in underserved areas.
Meanwhile, radiation oncologists have reported double-digit reimbursement declines nationally under a 2026 billing-code overhaul, highlighting how tightening, budget-neutral fee schedules have intensified specialty-versus-specialty fights over a dwindling pool of Medicare dollars.
CMS Response
CMS finalized the image-guided therapy rates "following a review of the available information and the public comments received through the rulemaking process," the agency told Politico. CMS also indicated it continues to meet with stakeholders regarding the services and "will continue to be open to hearing feedback on the effect of final policies for consideration in potential future rulemaking."