oncology clinical technology compendium
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Oncology clinical
technology compendium
Technology trends overview
Service Line Strategy Advisor
IMPLEMENTATION RESOURCE
advisory.com2© 2020 Advisory Board • All rights reserved
Oncology technology adoption landscape
Source: Service Line Strategy Advisor research and analysis. 1. Not profiled in Technology Compendium.
Subspecialty Conservative Late Majority Early Majority Early Adopter Progressive
Cancer
screening
and
diagnosis
• Breast coil
• Fecal occult
blood test
• Flexible
sigmoidoscopy
• Capsule video
endoscopy
• Optical
colonoscopy
• Dedicated
breast MRI
• Cologuard stool
DNA test
• Fecal
immunochemical
test
• Low-dose CT
lung screening
• Automated
breast
ultrasound
• CT colonography
• Endobronchial
ultrasound
• Electromagnetic
navigation
bronchoscopy
• Hyperthermic
intraperitoneal
chemotherapy
• Molecular breast
imaging
Interventional
and surgical
oncology
• Tumor
resection1
• Mohs
micrographic
surgery
• Laparoscopic
resection1
• Robotic
surgery
• Embolization
• Ablation
• Electronic
brachytherapy
• Hyperthermia
• Intraoperative
molecular
imaging
• Non-wire tumor
localization
• MR-guided
focused
ultrasound
• Drug eluting
beads
• Irreversible
electroporation
• High-intensity
focused
ultrasound
Medical
oncology
• Chemotherapy
infusion1
• Genetic testing
• Oral
chemotherapy
• Targeted cancer
therapies
• Immunotherapy
• Bone marrow
transplantation
• CAR T-cell
therapy
• Next-generation
sequencing
• Radiomics
• Liquid biopsy
• Companion
diagnostics
• Functional and
molecular imaging
• Pharmacogenics
• CDK4 inhibitors
Radiation
oncology
• CT simulation
• Low-dose
radiation
brachytherapy
• High-dose
radiation
brachytherapy
• Image-guided
radiation
therapy
• Three-
dimensional
conformal
radiation
therapy
• Intensity-
modulated
radiation
therapy
• Stereotactic
radiosurgery
• Stereotactic
body radiation
therapy
• Volumetric-
modulated arc
therapy
• Multi-functional
LINAC
• AccuBoost
breast
radiotherapy
• Intra-operative
radiation therapy
• Surface-guided
radiation therapy
• SpaceOAR
Hydrogel
• MRI-guided
radiation therapy
• Proton beam
therapy
• Single-room
proton beam
therapy
• Real-time
adaptive radiation
therapy
• Radiosensitivity
testing
• Respiratory gating
• 4D localization
(Calypso)
• Carbon ion
therapy
advisory.com3© 2020 Advisory Board • All rights reserved
Road map
Cancer screening and diagnosis
advisory.com4© 2020 Advisory Board • All rights reserved
6M
8M
2018 2023
Automated Breast UltrasoundABUS unlikely to increase competitiveness, but can improve efficiency
Source: Giuliano et al., Improved Breast Cancer Detection in
Asymptomatic Women Using 3DAutomated Breast Ultrasound
in Mammographically Dense Breasts, Clinical Imaging, 2013;
Service Line Strategy Advisor research and analysis.
1. http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DeviceApprovalsandClearances/Recently-
ApprovedDevices/ucm320724.htm
Cancer screening and diagnosis
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as
identified or mentioned herein. Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this
document or making any decisions regarding suppliers and providers.
What is it?
Automated breast ultrasound (ABUS) is a dedicated ultrasound platform equipped with an ultrasound
transducer that automatically acquires standardized breast images from different angles with minimal
sonographer intervention required.
Adoption status: Early Adopter
FDA status: FDA approved for diagnosis in 2008; approved for screening with U-Systems (GE) ABUS
device in September 20121
Major vendors: GE Healthcare (Invenia ABUS), Siemens (Acuson S2000 ABVS), Sonociné (Adjunctive
Breast Ultrasound System)
Competing products: 2D ultrasound, elastography, digital breast tomosynthesis, molecular
breast imaging, breast MRI
Key facts
CPT Description2019
Rate
2020
Rate
Percent
Change
76641Breast
Ultrasound$112 $111 -1%
Financial outlook National market estimatesBreast Ultrasound; Outpatient Imaging Market Estimator
Who should invest?
Investment in ABUS may be favorable for organizations that want to reduce image variation and improve
efficiency by uncoupling the image acquisition from interpretation. Further, given increased diagnostic
sensitivity for women with dense breasts, programs looking to be comprehensive breast centers should
consider ABUS.
Clinical considerations: ABUS increases diagnostic sensitivity for women with dense breasts
advisory.com5© 2020 Advisory Board • All rights reserved
802K
1M
2018 2023
Breast MRIBreast MRI important for high risk patients and secondary screenings
Source: Kelly, et al. Positron Emission Mammography
For the Diagnosis of Breast Cancer in Young Women:
a Literature Review. Internal Medicine, 2014; Service
Line Strategy Advisor research and analysis.
Cancer screening and diagnosis
What is it?
Breast MRI is the imaging of breast tissue involving either a whole-body MRI scanner or a dedicated unit
engineered specifically for breast imaging. Breast MRI requires a specialized coil optimized for breast imaging.
Software then processes images into three-dimensional renderings. Alternatively, a small number of vendors
offer breast-only MRI units.
Adoption status: Breast Coil – Late Majority; Dedicated Breast MRI – Early Adopter
FDA status: Approved
Major vendors: Aurora, GE, Phillips, Siemens, Toshiba
Competing products: Breast ultrasound, molecular breast imaging, tomosynthesis,
positron emission mammography (PEM)
Key facts
CPT Description2019
Rate
2020
Rate
Percent
Change
77046 /
77047
One or two
breast without
contrast
$230 $231 0%
National market estimatesBreast MRI; Outpatient Imaging Market Estimator
Who should invest?
Investment in breast MRI is best suited for organizations that have developed or attempting to develop a
comprehensive breast program, particularly those that see a lot of women at high risk for breast cancer.
Prior to investment, assess current patient volumes to determine the sustainability of purchasing a
breast MRI coil or a dedicated breast MRI unit.
Financial outlookMedicare HOPPS1 reimbursement
1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
Clinical considerations: Breast MRI is often recommended to be used as a screening tool
alongside an annual mammogram for certain women at high risk for breast cancer
advisory.com6© 2020 Advisory Board • All rights reserved
Capsule Video EndoscopyGood investment for programs looking to increase endoscopy volumes
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
A capsule endoscopy is a screening and diagnostic procedure that uses a tiny wireless camera to take pictures
of the digestive tract. A capsule endoscopy camera sits inside a vitamin-size capsule that is swallowed. As the
capsule travels through the digestive tract, thousands of photos are transmitted to a recorder the patient wears
on a belt around the waist.
FDA status: Currently three FDA approved
Payer coverage: Covered by Medicare and private payers
Adoption status: Late majority
Competing products: Optical colonoscopy, virtual CT colonoscopy, Epi proColonblood test,
Cologuard Stool DNA test, flexible sigmoidoscopy, fecal occult blood test
Key facts
Clinical considerations: A useful tool in evaluation of the small bowel for tumors such as lymphoma,
carcinomas or carcinoids, as it allows providers to view even the most inaccessible parts of the GI tract.
The procedure does not require sedation, has fewer potential complications, and is less likely to cause
discomfort.
HCPCS Description2019
rate
2020
rate
Percent
change
0355T
GI tract
capsule
endoscopy
through
colon
$1483 $1557 5%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesCapsule endoscopy volumes
Who should invest?
Capsule video endoscopy is a suitable investment for most AMCs and community centers, especially
those dealing with low uptake of colonoscopy or flexible sigmoidoscopy due to patient reluctance to
undergo invasive procedures.
Cancer screening and diagnosis
83K
115K
2018 2023
+39.3%
advisory.com7© 2020 Advisory Board • All rights reserved
Cologuard Stool DNA TestGood investment for programs with low screening volumes
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Clinical Lab Fee Schedule.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Cologuard is a non-invasive screening test for cancer that detects the presence of mutated DNA in stool.
Cologuard is an improvement on existing stool-based colon cancer screening tests because it detects pre-
cancerous lesions as well as the presence of cancer. Patients are prescribed a kit to use at home to collect the
stool sample. Positive results are followed by a diagnostic colonoscopy.
FDA status: Approved in 2014
Payer coverage: Covered by all major private payers and Medicare
Adoption status: Early majority; adoption increasing over time as awareness of test increases
Competing products: Colonoscopy, Virtual CT colonoscopy, fecal immunochemical tests (FIT),
Epi proColonblood test, FOBT, flexible sigmoidoscopy, capsule video endoscopy
Key facts
Clinical considerations: Colorectal cancer is often curable if detected early; however, many patients do
not receive colonoscopies at recommended intervals due to invasiveness of the test. Cologuard’s non-
invasive nature could potentially increase screening compliance and reduce colorectal cancer mortality
HCPCS Description2019
Rate
2020
Rate
Percent
change
81528
Oncology
colorectal
screening
$509 $509 0%
Financial outlookMedicare CLFS1 reimbursement
National market estimatesNational outpatient colonoscopy and sigmoidoscopy volumes
Who should invest?
As a potential lever to improve screening rates and ultimately outcomes, Cologuard is a strong investment
option for most organizations, especially those that are currently prioritizing population health or have low
screening colonoscopy volumes. However, organizations with moderate or high screening colonoscopy
volumes that still receive fee-for-service reimbursement should be wary of the potential negative impact
this could have on those volumes, although it may increase diagnostic colonoscopy volumes.
Cancer screening and diagnosis
7.0M
7.6M
297K 286K
2018 2023
+10%
Colonoscopy -
Diagnostic
-4%
Sigmoidoscopy
- Diagnostic
advisory.com8© 2020 Advisory Board • All rights reserved
87K
186K
2018 2023
CT ColonographyReasonable investment for comprehensive GI programs
Source: Johnson CD, Radiology, 2012. Service
Line Strategy Advisory research and analysis.
Cancer screening and diagnosis
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations
or their products as identified or mentioned herein. Advisory Board strongly recommends consulting legal counsel before
implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
CT Colonography (CTC), also referred to as “virtual colonoscopy” (VC), is a somewhat less invasive alternative
to traditional endoscopic colonoscopy. CTC utilizes CT imaging in place of optical endoscopy to visualize both
the interior and exterior of the colon.
Adoption status: Early adopter
FDA status: FDA approved
Major vendors: GE, Philips, Siemens, Toshiba; CAD available from iCAD, Viatronix, Vital Images,
Medicsight
Competing products: Optical/standard colonoscopy, flexible sigmoidoscopy, MR colonography,
barium enema, fecal immuno-histological testing
Key facts
CPT Description2019
Rate
2020
Rate
Percent
Change
74261Diagnostic CT
Colonography$112 $111 -1%
74262Diagnostic CT
Colonography
with contrast
$201 $179 -12%
74263Screening CT
ColonographyNot paid Not paid N/A
Financial outlook National market estimatesCT Colonography; Outpatient Imaging Market Estimator
Who should invest?
CTC is a suitable investment for GI programs that are seeking to differentiate themselves by offering a
noninvasive alternative to traditional endoscopic colonoscopy. Organizations looking to use CTC for both
screening and diagnostic purposes should ensure they see more commercially insured patients than
Medicare patients since Medicare does not cover screening CTC.
Payer coverage: Medicare covers diagnostic CTC, but not screening CTC; many private payers cover
both applications. Nearly half of states mandate coverage for screening CTC for appropriate patients.
advisory.com9© 2020 Advisory Board • All rights reserved
Electromagnetic Navigation BronchoscopyPotential to help capture downstream revenue in radiotherapy and radiosurgery
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Electromagnetic navigation bronchoscopy (ENB) is a visual guidance method that combines a flexible catheter
with image navigation to extend the diagnostic and therapeutic reach of conventional bronchoscopy to
peripheral regions of the lungs. Guides pulmonologists to suspicious lesions previously available only through
open procedure, allowing minimally-invasive diagnostic and therapeutic applications in a larger patient pool.
FDA status: FDA Approved
Payer coverage: Private payers still do not offer additional payment for use of a navigation system;
Medicare covers and reimburses at the APC level when considered medically necessary
Adoption status: Early adopter
Competing products: Computed tomography (CT), ultrasound, fluoroscopy
Key facts
Clinical considerations: Although the technology is not currently approved for use outside the lung,
researchers see a potential role in gynecologic and gastrointestinal disease. ENB is best viewed as one
component of a multi-modality screening program, as ENB is a niche technology used for a subset of at-
risk patients, specifically those with small lesions in peripheral nodules
APC Description2019
rate
2020
rate
Percent
change
5153
Level 3
Airway
Endoscopy
$1369 $1430 5%
5154
Level 4
Airway
Endoscopy
$2740 $2936 7%
5155
Level 5
Airway
Endoscopy
$5147 $5439 6%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesNational OP bronchoscopy volumes
Who should invest?
AMCs will likely find greater utilization with this technology as it is the gold standard for fiducial marker
placement and downstream radiotherapy or radiosurgical services. However, community hospitals may
find increasing value in ENB systems as a critical component to lung cancer screening programs, though
it may not be “need to have” technology.
Cancer screening and diagnosis
149K173K
348K
455K
2018 2023
+31%
Procedural
Bronchoscopy
+15.9%
Diagnostic
Bronchoscopy
advisory.com10© 2020 Advisory Board • All rights reserved
Endobronchial UltrasoundCritical for thoracic centers of excellence
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Endobronchial ultrasound (EBUS) is a noninvasive imaging modality that locally visualizes lesions in the lungs
and mediastinal lymph nodes for real-time staging of lung cancer, lung infections, and other conditions that
result in enlarged lymph nodes or masses in the chest. EBUS utilizes an ultrasound transducer affixed to a
specially-designed bronchoscope that is inserted into the lungs to locally visualize lesion depth and size for
lung cancer detection and staging. EBUS can also be utilized with trans-bronchial needle aspiration (TBNA) to
acquire tissue specimens for testing, or in some cases, to deliver targeted neoadjuvant therapy.
FDA status: Approved
Payer coverage: Three CPT codes created in 2016 for EBUS; previously considered a packaged
service with standard endoscopic ultrasound. CMS/commercial coverage provided when proven
advantageous to standard bronchoscopy.
Adoption status: Early adopter; limited to large oncology programs or institutions with extensive
interventional pulmonology programs
Competing products: Computed tomography (CT), ENB, ultrasound, fluoroscopy
Key facts
Clinical considerations: Especially useful for the diagnosis of non-small cell lung cancer (NSCLC), which
accounts for approximately 80% of all lung cancers. When combined with endoscopic ultrasound (EUS),
EBUS establishes accurate mediastinal staging thus replacing more invasive and costly procedures like
mediastinoscopy
HCPCS Description2019
rate
2020
rate
Percent
change
31652
Bronch ebus
sampling ½
node
$2740 $2936 7%
31653
Bronch ebus
sampling 3/>
node
$2740 $2936 7%
31654
Bronch ebus
ivntj perph
les
n/a n/a n/a
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesNational OP bronchoscopy volumes
Who should invest?
EBUS is a sound investment for thoracic centers of excellence and other large oncology programs.
However, it requires physicians to be highly skilled in both bronchoscopy and ultrasound, which can be a
limiting factor when investing and is a major reason for limited availability. Even so, while there is
possibly a low case-load in first years of adoption as physicians acclimate to the technology, it is
important for distinguishing a thoracic center of excellence.
Cancer screening and diagnosis
149K173K
348K
455K
2018 2023
+31%
Procedural
Bronchoscopy
+15.9%
Diagnostic
Bronchoscopy
advisory.com11© 2020 Advisory Board • All rights reserved
Fecal Immunochemical TestNon-invasive exam worth the investment for most programs
Source: “Important Information Regarding Reimbursement for
Fecal Occult Blood Testing” , https://www.ndc-inc.com/vendor-
spotlight/what-your-accounts-need-to-know-about-reimbursement-
of-ifob; Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Clinical Lab Fee Schedule.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
The fecal immunochemical test (FIT), also known as an immunochemical fecal occult blood test (iFOBT), is a
colorectal cancer screening test that checks for hidden blood in stool. The test reacts to part of the human
hemoglobin protein, which is found in red blood cells. Done in the privacy of the home, stool is collected in a
special collection tube or card and sent off for testing.
FDA status: Approved
Payer coverage: Covered by Medicare and private payers; Medicare covers one FOBT (either iFOBT or
gFOBT) per year for the early detection of colorectal cancer
Adoption status: Early majority
Competing products: Optical colonoscopy, virtual CT colonoscopy, Epi proColon blood test,
Cologuard Stool DNA test, gFOBT, capsule video endoscopy, flexible sigmoidoscopy
Key facts
Clinical considerations: Colorectal cancer is often curable if detected early, however, many patients do
not receive colonoscopies at recommended time intervals due to the invasiveness of the test. The FIT test
could increase screening compliance and reduce colorectal cancer mortality, and is more sensitive than
other tests like gFOBT, though it can occasionally give false positives.
HCPCS Description2019
rate
2020
rate
Percent
change
G0328
Blood, occult by
fecal
hemoglobin
determination
by
immunoassay
$18 $18 0%
Financial outlookMedicare CLFS1 reimbursement
National market estimatesOutpatient fecal occult blood test volumes
Who should invest?
Despite it’s risk of false positives, FIT’s inexpensiveness and increased specificity compared to gFOBT
tests make it a worthwhile investment for all organizations, especially those prioritizing population health
or experiencing low uptake of screening colonoscopy among their patient population.
Cancer screening and diagnosis
3.6M
4.8M
2018 2023
+33.1%
advisory.com12© 2020 Advisory Board • All rights reserved
Fecal Occult Blood TestCheap and insensitive, can still improve mortality rates for colorectal cancer
Source: Advisory Board Outpatient Market
Estimator; Service Line Strategy Advisor
research and analysis.1. Clinical Lab Fee Schedule.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
The fecal occult blood test, or guaiac fecal occult blood test (gFOBT), is a colorectal cancer test that checks for
hidden blood in stool. The test uses guaiac paper and hydrogen peroxide to react to any traces of blood. Done
in the privacy of the home or doctor’s office, stool is collected on a special collection card and sent off for
testing.
FDA status: Approved
Payer coverage: Covered by Medicare and private payers, Medicare covers one screening FOBT (either
iFOBT or gFOBT) per year for the early detection of colorectal cancer.
Adoption status: Late majority
Competing products: Optical colonoscopy, Virtual CT colonoscopy, Epi proColonblood test,
Cologuard stool DNA test, FIT, capsule video endoscopy, flexible sigmoidoscopy
Key facts
Clinical considerations: Colorectal cancer is often curable if detected early, however, many patients do
not receive colonoscopies at recommended time intervals due to the invasiveness of the test. The gFOBT
could increase screening compliance and reduce colorectal cancer mortality, as it is one of the cheapest
options for colorectal cancer screening, though it is less sensitive than FIT and can occasionally give false
positives.
HCPCS Description2019
rate
2020
rate
Percent
change
82270Occult blood
feces$4 $4 0%
Financial outlookMedicare CLFS1 reimbursement
National market estimatesOutpatient fecal occult blood test volumes
Who should invest?
gFOBT, while less sensitive than FIT, is still a worthwhile investment for organizations prioritizing
population health or experiencing low uptake of screening colonoscopy among their patient population.
Cancer screening and diagnosis
3.6M
4.8M
2018 2023
+33.1%
advisory.com13© 2020 Advisory Board • All rights reserved
Flexible SigmoidoscopyLess invasive procedure an easy investment for any cancer center
Source: Advisory Board Outpatient Market
Estimator; Service Line Strategy Advisor
research and analysis.1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Flexible sigmoidoscopy allows a doctor to look at part of the colon and rectum with a sigmoidoscope (a flexible,
lighted tube about the thickness of a finger with a small video camera on the end). It’s put in through the anus
and into the rectum and moved into the lower part of the colon. Images from the scope are seen on a video
screen. It is used as a general screening tool for colon cancer as well as a diagnosis tool for various bowel
symptoms; suspicious findings may require a follow-up full colonoscopy as it cannot be used to remove polyps.
FDA status: Approved
Payer coverage: Covered by Medicare and private payers
Adoption status: Late majority
Competing products: Optical colonoscopy, Virtual CT colonoscopy, Epi proColon blood test,
Cologuard Stool DNA test, FIT, capsule video endoscopy, FOBT
Key facts
Clinical considerations: Colorectal cancer is often curable if detected early, however, many patients do
not receive colonoscopies at recommended time intervals due to the invasiveness of the test. Flexible
sigmoidoscopy could increase screening compliance and reduce colorectal cancer mortality, as it is a less
invasive procedure (checking less of the colon than a full colonoscopy), does not require sedation, and has
a lower risk of direct harm due to perforation.
HCPCS Description2019
rate
2020
rate
Percent
change
45330Diagnostic
sigmoidoscopy$745 $764 3%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient sigmoidoscopy diagnostic/screening volumes
Who should invest?
Although not a complete replacement for colonoscopy, flexible sigmoidoscopy is a worthwhile investment
for any organization looking to increase screening compliance by offering a less invasive option to
traditional screening colonoscopy.
Cancer screening and diagnosis
297K 286K
2018 2023
-3.8%
advisory.com14© 2020 Advisory Board • All rights reserved
2018 2023
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations
or their products as identified or mentioned herein. Advisory Board strongly recommends consulting legal counsel before
implementing any practices contained in this document or making any decisions regarding suppliers and providers.
Low-Dose CT Lung ScreeningCritical investment for all organizations with robust lung cancer programs
What is it?
Low-dose CT (LDCT) lung screening is an FDA-approved, non-invasive imaging modality used for the detection of lung
cancer. This exam has proven promising due to the high sensitivity of CT in detecting smaller lung lesions, though
adoption is limited. Unlike conventional 2D chest x-ray, lung screening with CT uses a multi-detecter CT scanner
(commonly 16-slice or greater) to capture 2D images and aggregate them into a 3D reconstruction of the pulmonary
structures and visualize potentially cancerous nodules.
Key facts
Who should invest?
Source: Harry J. de Koning, M.D., et al. “Reduced Lung-Cancer Mortality with Volume CT Screening in a
Randomized Trial”, New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1911793.
National Lung Screening Trial Research Team, “Reduced lung-cancer mortality with low-dose computed tomographic
screening,” New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1102873. Cancer
Incidence Estimator. Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
Financial outlookEstimated HOPPS1 reimbursement
National market estimatesEstimated lung cancer incidence
Adoption status: Early majority
Major vendors: Low-dose CT vendors; GE, Philips, Siemens, Toshiba
Competing products: Digital x-ray tomosynthesis (screening and diagnosis), hybrid PET/CT (staging, re-staging, and
treatment planning)
Clinical considerations: Early results from the National Lung Screening Trial (NLST) suggest a 20% reduction in lung
cancer-related mortality with CT lung screening. Some studies show mortality reductions from 36%-64%; however,
other trials have suggested a propensity toward over-diagnosis. Results from the Dutch-Belgian Randomized Lung
Cancer Screening trial found a 24% reduction in lung cancer-related mortality for men and 33% reduction for women
with CT lung screening versus no screening. The US Preventative Services Task Force (USPSTF) advises that those at
highest lung cancer risk receive low-dose scans annually. CT vendors have been developing scanning protocols that
can reduce radiation dose dramatically, as receiving multiple low-dose CT exams over time could increase the lifetime
attributable risk for lung cancer.
Low-dose CT screening is a necessary investment for any organization with a comprehensive lung cancer
program. Organizations located in markets with high smoking rates are also strong candidates for investment.
However, given the strong clinical evidence supporting positive outcomes for patients, advice from USPSTF,
and growing lung cancer incidence rates, LCDT is a suitable investment for most cancer programs.
263K
233K
HCPCS Description2019
rate
2020
rate
Percent
change
G0296Visit to determine
ldct eligibility$76 $79 5%
G0297Ldct for lung
cancer screening$62 $80 29%
+13%
Cancer screening and diagnosis
advisory.com15© 2020 Advisory Board • All rights reserved
Molecular Breast ImagingImproved specificity, sensitivity give AMCs opportunity to differentiate themselves
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Molecular breast imaging (MBI) represents a class of novel nuclear medicine imaging modalities designed to
provide high-resolution functional imaging of breast tissue. A secondary screening tool for breast cancer, it
captures the increased metabolism present in cancerous cells through the use of targeted radiotracers. MBI
utilizes technetium-99 to target breast lesions.
FDA status: FDA ApprovedPayer coverage: Covered by all major private payers and CMS
Adoption status: Progressive; limited to leading breast imaging facilities, centers seeking to differentiate
from competitionCompeting products: Breast ultrasound, contrast-enhanced spectral mammography, magnetic
resonance imaging (MRI), tomosynthesis
Key facts
Clinical considerations: With improved specificity over breast MRI, MBI helps physicians to better
understand lesion malignancy. Provides similar results to breast MRI for pre-surgical planning and to
mammography for high risk or dense-breasted screening. MBI also has potential to replace MRI in pre-
surgical planning for women with contraindications to MRI
HCPCS Description2019
rate
2020
rate
Percent
change
78800,
78801
Tumor
imaging,
limited,
multiple
$353 $368 4%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesNational OP breast imaging volumes
Who should invest?
For AMCs, MBI is a differentiating technology and provides another breast screening option for select
patient groups. It is a good option for organizations with a high number of patients interested in
alternatives to a breast MRI exam. For community hospitals, MBI is not yet seen as a must-have for
majority of breast centers due to limited volume and numerous other competing technologies.
Cancer screening and diagnosis
2.1M
2.4M
766K982K
2018 2023
+15%
3D Diagnostic
Mammography
+28%
Breast MRI
advisory.com16© 2020 Advisory Board • All rights reserved
Optical ColonoscopyMost effective colorectal screening also the most invasive
Source: Advisory Board Outpatient Market Estimator;
Service Line Strategy Advisor research and analysis.1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
An optical colonoscopy allows a provider to look at the entire length of the colon and rectum with a
colonoscope, a flexible tube about the width of a finger with a light and small video camera on the end. It’s put
in through the anus and into the rectum and colon to look for any abnormal areas that might be cancer or
polyps. It can be used for screening and diagnosis, and any identified polyps can be removed immediately
during the procedure.
FDA status: Approved
Payer coverage: Covered by Medicare and private payers
Adoption status: Late majority; colonoscopies are currently the most common screening test for colorectal
cancer in the US
Competing products: Virtual CT colonoscopy, Epi proColon blood test, Cologuard stool DNA
test, flexible sigmoidoscopy, fecal occult blood test, FIT, capsule video endoscopy
Key facts
Clinical considerations: A full colonoscopy requires bowel cleaning and sedation, which can be
uncomfortable for patients and lead to lower rates of screening. It has the highest cost of other screening
methods. However, a colonoscopy is the most thorough colorectal screening exam, negative results clear
patients for 10 years due to the thorough nature of the exam, and it can even serve as treatment during the
same procedure.
HCPCS Description2019
rate
2020
rate
Percent
change
G0105
Colorectal
cancer
screening;
colonoscopy on
individual with
high risk
$745 $764 3%
G0121
Colorectal
cancer
screening;
colonoscopy on
individual not
meeting criteria
for high risk
$745 $764 3%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesColonoscopy diagnostic/screening volumes
Who should invest?
As the most common screening test for colorectal cancer in the US, it is likely that most organizations will
have already invested in this procedure. Since it is used as a follow-up for positive results from most other
colorectal screening modalities, this is a must-have for any organizations that have not yet invested.
Cancer screening and diagnosis
7.0M
7.6M
2018 2023
+10%
advisory.com17© 2020 Advisory Board • All rights reserved
Road map
Surgical oncology
advisory.com18© 2020 Advisory Board • All rights reserved
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
Da Vinci Surgical SystemSurgical robots are now cost of doing business and less of a market differentiator
What is it?
The da Vinci Robotic Surgery System from Intuitive Surgical, Inc. is a minimally invasive alternative to
traditional open and laparoscopic surgery. The surgeon performs surgery from a seated position at a console
away from the patient. Robotic arms allow the surgeon to manipulate the endoscope and surgical tools with
greater ease, more precision, and enhanced visualization.
Key facts
Who should invest?
Source: “Annual Report 2018”, Intuitive
Surgical, Inc. Retrieved from:
http://www.annualreports.com/HostedData/Ann
ualReports/PDF/NASDAQ_ISRG_2018.pdf
Market Scenario Planner. Advisory Board
research and analysis.
1. All costs are estimates and will vary by institution.
National inpatient market estimatesService lines with highest robotic surgery adoption
2018 2023
Gynecology Urology General Surgery
Cost description Cost
da Vinci robot $2M
Training $6K per surgeon
Proctoring $3K per surgeon
Annual marketing $25K
Instrumentation $2K per procedure
Annual contract fee $170K
Adoption status: Late majority for urology & gynecology; early majority for other services lines
FDA status: Approved
Operational needs: due to da Vinci’s size, it must be placed in a large OR; adoption of robotic technology initially slows
throughput and also requires a trained OR care team including anesthesiologist, nurse, and assistant.
Clinical considerations: The majority of clinical literature suggests the robot can substantially decrease length-of-stay
(LOS) and blood loss for prostatectomy. While for most other procedures clinical results are mixed, the robot does offer
additional benefits over traditional laparoscopic approaches.
• Organizations with substantial surgeon interest, sufficient volumes of robotic eligible procedures, and
access to capital may be good candidates for investment.
• New physicians continue to drive demand for investment the da Vinci, as their training often includes
robotic procedures. The robotics market is growing though, as use of da Vinci robots increased 18%
overall and 32% in general surgery from 2017 to 2018.
2.40M 2.38M
454K375K
467K342K
Costs associated with da Vinci investment1
Surgical oncology
advisory.com19© 2020 Advisory Board • All rights reserved
Hyperthermic Intraperitoneal ChemotherapyFewer side effects coupled with clinical benefit help alleviate cost
Source: Squires MH 3rd et al, “Association between hospital finances, payer mix, and complications after hyperthermic intraperitoneal chemotherapy:
deficinecies in the current healthcare reimbursement system and future implications, (https://www.ncbi.nlm.nih.gov/pubmed/25249258); Advisory
Board Cancer Incidence Estimator; Service Line Strategy Advisor research and analysis.
1. Inpatient Prospective Payment System.
2. Incidence represents the number of new cancer cases.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Hyperthermic (or heated) intraperitoneal chemotherapy (HIPEC) is an abdominal surgical procedure wherein
after visible tumors are removed from the abdomen with cytoreductive surgery, a powerful dose of heated
chemotherapy is pumped inside the patient’s abdomen. The 41-42 degrees Celsius chemo bath circulates
through the peritoneal cavity, and after 90 minutes the chemo is washed out and incisions are closed.
FDA status: Approved in 2009
Payer coverage: Covered by Medicare and private payers
Adoption status: Early adoption; over 115 centers in the US currently offer HIPEC
Competing products: Standard chemotherapy, targeted therapy, radiation therapy
Key facts
Clinical considerations: Fewer side effects than traditional chemotherapy because confining the
treatment to the stomach cavity allows for a higher dosage to be administered without causing adverse
effects elsewhere in the body; higher temperature of the chemicals cause blood vessels to expand, leading
to deeper penetration for better absorption
DRG/
CPTDescription
2019
rate
2020
rate
Percent
change
356
Oth. dig.
Sys. O.R.
proc w
MCC
$24,274 $25,539 5%
357
Oth. dig.
Sys. O.R.
proc w CC
$13,046 $14,096 8%
358
Oth. dig.
Sys. O.R
proc w/o
cc/MCC
$8,232 $8,591 4%
965
49
Unlist
chemo.
proc
$38 $38 0%
Financial outlookMedicare IPPS1 reimbursement
National market estimatesNational stomach cancer incidence2
Who should invest?
HIPEC could be a clinical differentiator for AMCs and community organizations with comprehensive
abdominal cancer programs. However, the financial case for investment is stronger for organizations that
treat more commercially insured patients than Medicare patients, as the procedure is only profitable with
private payer reimbursement rates.
Surgical oncology
25K
28K
2018 2023
+12%
advisory.com20© 2020 Advisory Board • All rights reserved
Intraoperative Molecular ImagingBreast centers should invest to gain immediate feedback and better margins
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Intraoperative molecular imaging uses to visualize remaining cancer cells via molecular probes targeting tumor
markers. There are many different imaging modalities that can be used for molecular imaging, but optical
imaging is most commonly used intraoperatively for cancer detection. Currently used in only breast surgeries,
tissue can be evaluated while still in the operating room, reducing the need for follow-up surgeries.
Adoption status: Early adopter
FDA status: MarginProbe, approved in 2012, is currently the only intraoperative imaging system with FDA
approval, but there are other systems of various stages of development in the pipeline; LightPath Imaging
System has a CE mark and is approved for sale in the European Union, but has not received FDA
approval yet
Payer coverage: MarginProbe is reimbursed for its use in cancer surgeries by Medicare and private payers
Competing products: Standard post-surgery pathology testing
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
19499
Unlisted procedure,
breast (when specified
as intraoperative
assessment of surgical
margins by
radiofrequency
spectroscopy)
$2,816 $3,029 8%
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Surgical oncology
Clinical considerations: The use of intraoperative molecular imaging systems allows for evaluation of
surgical tissue in the operating room, allowing surgeons to remove excess cancer cells in the margins
immediately without having to wait for a pathologist to examine the removed tissue. This reduces the need
for follow-up surgeries.
Intraoperative molecular imaging is a viable investment option for any institution looking to differentiate itself
as a breast center of excellence, though community programs may find the initial cost of a system
prohibitive. This technology may also have a unique appeal to institutions currently participating in or
preparing to participate in value-based payment models that are looking to decrease costs given its ability to
reduce the need for potentially costly follow-up surgeries.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
National market estimatesOutpatient oncology lumpectomy volumes2
144K131K
2018 2023
-9.1%
advisory.com21© 2020 Advisory Board • All rights reserved
Non-Wire Tumor LocalizationLower patient pain and lower complications increase viability
Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes are represented in the outpatient module by unique visits with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Tumor localization uses non-radioactive markers and detection probes to identify target tissue for surgical
removal. Using a small reflector or magnetic lesion marker detected by radar or a handheld magnetometer,
surgeons can precisely target the affected tissue to pinpoint its location. Currently used for lumpectomies in
breast cancer patients.
FDA status: SAVI SCOUT approved in 2014, Sentimag Magseed approved in 2016
Payer coverage: Covered by Medicare and private payers
Adoption status: Early adopter; over 125 centers currently use SAVI SCOUT
Competing products: MRI, wire localization
Key facts
Clinical considerations: Tumor localization allows surgeons to better visualize tumors, making it a useful
tool to optimize surgical planning, reduce surgical delays and the need for follow-up surgeries, and improve
patient satisfaction compared to a more painful wire localization.
HCPCS Description2019
rate
2020
rate
Percent
change
19081
Biopsy, breast, with
placement of breast
localization device(s)
(e.g., clip, metallic
pellet), when
performed, and
imaging of the
biopsy specimen,
when performed,
percutaneous; first
lesion, including
mammographic
guidance
$1,376 $1,372 -0%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology lumpectomy volumes2
Who should invest?
Non-wire tumor localization is a viable investment option for any institution looking to differentiate itself
as a breast center of excellence. Although community programs may initially find the cost prohibitive, the
immediate significant impact that this technology can have on reducing OR delays presents an
opportunity to recoup some of the upfront costs.
Surgical oncology
144K131K
2018 2023
-9%
advisory.com22© 2020 Advisory Board • All rights reserved
Road map
Interventional oncology
advisory.com23© 2020 Advisory Board • All rights reserved
AblationMore progressive ablation techniques best suited to AMC investment
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System
2. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Ablations are minimally invasive procedures that use extreme temperatures or other energy sources to target
and destroy tumor cells. Common types of ablation include cryoablation, radiofrequency ablation (RFA),
microwave ablation (MWA), ethanol ablation, and laser ablation. These procedures are usually performed by
an interventional radiologist who will percutaneously guide a needle or probe to the tumor to apply the energy
source. Ablations can be curative treatments for small tumors (usually <3cm); they are also used in conjunction
with other therapies and palliative procedures.
FDA status: Several devices are cleared for marketing through 510(k) process
Payer coverage: RFA and cryoablation are covered by Medicare and most payers; MWA currently has
no specific cpt codes for reimbursement, and the American Medical Association recommends using CPT
codes for RFA
Adoption status: Early majority; use of cryoablation and RFA is more widespread, while use of microwave,
ethanol, and laser ablations is limited to research
Competing products: Transcatheter arterial chemoembolization, CT-guided high dose brachytherapy
Key facts
Clinical considerations: Cryoablation. RFA, and MWA are primarily used to treat liver, kidney,
bone, and lung tumors; RFA is usually the first option for hepatocellular carcinoma (HCC), but
cryoablation is preferred for recurrent cancers or those near blood vessels.
HCPCS Description2019
rate
2020
rate
Percent
change
47382Percute ablate
liver RF$4596 $4833 5%
47383Percute ablate
liver cryo$4596 $4833 5%
20982Ablate bone
tumor(s) perq$5700 $5981 5%
50593
Percute cryo
ablate liver
tumor
$7741 $8412 9%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology ablation volumes2
Who should invest? Ablation is best suited for AMC investment or larger research institutions with a
highly specialized cancer program. Volumes are currently low but growing quickly, and these procedures
expand an institution’s interventional oncology program, which is an increasingly recognized component
of a comprehensive cancer program. Smaller, less well-funded programs should carefully weigh the
expected benefit to patients and number of eligible patients against the steep $25K-$30K-cost of these
systems when deciding whether to invest.
Interventional oncology
12K
16K
4K 4K3K 3K
2018 2023
+35%
RFA liver
volumes
+23%
Cryoablation
liver volumes
+18%
RFA bone
volumes
advisory.com24© 2020 Advisory Board • All rights reserved
Drug-Eluting Beads Niche investment case for organizations developing liver cancer programs
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Drug-Eluting Beads (DEBs) are synthetic microspheres that are injected into the vessels that supply blood to a
tumor, where they release a chemotherapy agent and obstruct blood supply. DEBs are coated in a hydrogel
with molecular properties that allow them to attach to a chemotherapeutic agent. Once the beads have been
combined with the agent, they are admioniosteted int the arterioles feeding the tumor via a microcatheter
inserted throught the femoral artery. Once there, they release the chemotherapeutic agent and obstruct the
vessels supplying blood to the tumor.
FDA status: LC Beads and Quadraspheres were approved as embolization devices in 2006. However,
neither product is approved for chemo delivery in the US even though they are approved for this
indication in Europe
Payer coverage: FDA-approved indicators are generally reimbursed. Reimbursement for non-FDA
approved indications is largely limited to patients on clinical trials and may need to be secured on a
case-by-case basis.
Adoption status: Progressive; currently offered at 20-25 sites within the US
Competing products: Chemotherapy, conventional transarterial
chemoembolization,(cTACE), radiofrequency ablation, resection
Key facts
Clinical considerations: DEBs allow for targeted delivery of a chemotherapy agent to liver
tumors in patients ineligible for surgery. DEBs are also used for embolization of primary
hypervascular tumors and AVMs
HCSPCS Description2019
rate
2020
rate
Percent
change
37241
Vascular
embolizatio
n/
occlusion,
venous
$9669 $9907 3%
37242
Vascular
embolizatio
n/occlusion,
arterial
$9669 $9907 3%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient transcatheter embolization volumes
Who should invest?
Liver tumor chemoembolization is a potential niche offering for AMCs and centers with interventional
radiologists seeking to distinguish themselves in competitive markets, particularly those organizations
trying to develop and market liver cancer programs. However, the market opportunity for hepatocellular
carcinoma is relatively low as liver tumors are a low-volume malignancy.
Interventional oncology
+66.6%
23K
39K
2018 2023
advisory.com25© 2020 Advisory Board • All rights reserved
EmbolizationsPotential niche offering to differentiate comprehensive liver cancer programs
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System
2. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Embolizations are minimally invasive procedures that use embolic agents, delivered via a catheter, to block
blood flow to a certain area of the body. In oncology, providers block the hepatic artery, which primarily
supplies blood to the tumor cells, while the portal vein continues to supply blood to the liver. By cutting off the
tumor’s blood supply, embolizations aim to induce tumor necrosis to prolong patient survival.
FDA status: Drug-eluting bead transarterial chemoembolization (DEB-TACE) is not yet FDA approved
for chemotherapy, while bland transarterial embolization (TAE) is FDA approved.
Payer coverage: Routinely covered by payers including Medicare and Medicaid, reimbursement
continues to increase in the case of Y-90; however DEB-TACE is not reimbursed
Adoption status: While TAE and TACE are more widespread, DEB-TACE is still in the research phase;
progressive
Competing products: Surgery, chemotherapy, radiation therapy, and ablations
Key facts
Clinical considerations: Although TACE is currently the most popular standard treatment for HCC,
there is limited evidence demonstrating which modality yields the best outcomes for patients with
liver cancer. Most studies have not shown significant differences in overall survival when comparing
TACE and DEB-TACE, but studies have shown patients treated with DEB-TACE have fewer side
effects and require fewer treatments. Many recent studies have also demonstrated clinical
superiority of Y-90 over chemoembolization in reducing toxicity to HCC patients and increasing their
time to disease progression
HCPC
SDescription
2019
rate
2020
rate
Percent
change
37243
Vasc
embolize
organ
$9669 $9907 3%
C2616Addition of
Y-90$16625 $17089 3%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient transcatheter embolization volumes2
Who should invest?
Embolization procedures are best suited for AMCs and other progressive cancer programs are best
suited to invest in embolization procedures. Community centers should be wary about offering these
procedures until there is more robust clinical evidence on the superiority of each embolization modality
compared to each other and alternative treatments.
Interventional oncology
102K
170K
2018 2023
+66.6%
advisory.com26© 2020 Advisory Board • All rights reserved
High-Intensity Focused UltrasoundStill in early stages, HIFU shows promising, yet expensive, results
Source: HIFU Prostate services, “HIFU reimbursement”,
https://www.hifuprostateservices.com/hifu-reimbursement/;
Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Due to lack of clinical evidence validating claims that HIFU has fewer side effects than
traditional cancer treatment
2. Hospital Outpatient Prospective Payment System
3. Prostatectomy DRGs included: 665, 666, 667
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
High-intensity focused ultrasound (HIFU) is a non-invasive therapy that uses focused ultrasound waves to
thermally ablate a portion of tissue. The intense heat causes tissue coagulation, cavitation and heat shock in
the cells, meaning that the portion of tissue which is being abated is destroyed.
FDA status: Approved two types of HIFU treatments for prostate cancer in 2015
Payer coverage: Medicare covered a substantial part of the HIFU cost from mid-2017 through 2018, but
cut reimbursement for HIFU to less than the cost of the supplies needed to perform the procedure in
20191; not covered by private payers
Adoption status: Progressive, only a few sites within the US
Competing products: Drug therapy, surgery, radiotherapy
Key facts
Clinical considerations: Primarily performed by urologists as an alternative to radiation or
surgery for prostate cancer patients; requires shorter treatment time and early results
indicate fewer side effects than standard surgical or radiation therapies because HIFU only
targets diseased cells, minimizing the negative impact on the essential nerves, blood
vessels, and muscles surrounding the prostate that are critical for sexual function and
urinary continence
HCPCS Description2019
rate
2020
rate
Percent
change
C9747
Ablation,
HIFU,
Prostate
$4021 $4231 5%
Financial outlookMedicare HOPPS2 reimbursement
National market estimatesOutpatient radiation therapy and inpatient prostatectomy volumes
Who should invest?
Only major AMCs with a larger number of self-pay prostate cancer patients are currently well-positioned
to invest in HIFU given then limited payer coverage of the treatment.
Interventional oncology
3.4M
3.9M
937 8222018 2023
+26.1%
Outpatient
radiation
therapy
volumes
-12% Inpatient
Prostatectomy3
volumes
advisory.com27© 2020 Advisory Board • All rights reserved
Hyperthermia Increased payer coverage and effectiveness make a compelling case for AMCs
Source: Oncology Market Estimator, Service
Line Strategy Advisor research and analysis
1. Hospital Outpatient Prospective Payment System
2. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Hyperthermia raises the temperature of a tumor to 108-113⁰ F for one hour to increase efficacy of radiation
therapy (RT) or chemotherapy. It may also be used as a stand alone treatment. Treatment can be delivered
locally or regionally. Local hyperthermia applies heat to a small area through microwave, radiofrequency, and
ultrasound. Regional hyperthermia applies heat to large tissue areas, such as an organ or limb, using
microwave or radiofrequency energy.
FDA status: Only a few FDA-approved hyperthermia systems on the market
Payer coverage: Covered by most private payers and Medicare
Adoption status: Early adopter stage; adoption growing as supporting clinical evidence emerges
Competing products: Surgery, radiation therapy, chemotherapy
Key facts
Clinical considerations: Utilized for palliative management of advanced or recurrent surface and
subsurface solid malignant tumors; used as adjuvant to radiation therapy and, less often, chemotherapy;
there is clinical evidence of effectiveness in increasing tumor response to RT, making it an additional
treatment option for patients with poor prognosis
HCSPCS Description2019
Rate
2020
Rate
Percent
change
77600Hyperthermia
treatment$224 $236 5%
77605Hyperthermia
treatment$705 $740 5%
77610,
15, 20
Hyperthermia
treatment$520 $539 4%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology radiation treatment volumes2
Who should invest?
Major AMCs and other high-volume cancer centers are best positioned to offer hyperthermia as an
adjunctive or standalone treatment option. Although the high cost of the console is potentially prohibitive
for most lower-volume community hospitals, increasing reimbursement rates and leasing options may
pose solutions for mitigating risk.
Interventional oncology
-6.9% Outpatient
radiation treatment
- conventional
6.7M6.2M
2018 2023
advisory.com28© 2020 Advisory Board • All rights reserved
Irreversible ElectroporationExpensive and experimental, IRE nonetheless shows promising results
Source: Advisory Board Oncology Market
Estimator; Advisory Board Interventional
Radiology Outpatient Estimator; Service Line
Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System
2. Reimbursement for IRE projected to follow coding guidelines for RFA, but currently not
reimbursed because still experimental
3. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Irreversible electroporation (IRE) is a soft-tissue ablation technique using ultra short but strong electrical fields
to create permanent and hence lethal nanopores in the cell membrane to disrupt cellular homeostasis. The
resulting cell death results from apoptosis(controlled cell death) and not necrosis as in all other thermal or
radiation based ablation techniques.
FDA status: NanoKnife received 510(k) clearance in 2008 for ablation of soft-tissuePayer coverage: For virtually all patients, there is typically no coverage by commercial health insurers,
or Medicare for IRE at this time, considered investigational
Adoption status: Progressive; because IRE is currently only performed in clinical research trials for patients
who do not qualify for other ablative methods.
Competing products: Drug therapy, surgery, radiofrequency ablation, cryoablation
Key facts
Clinical considerations: IRE has the potential to be used for larger tumors and tumors close to other vital
organs or blood vessels because it destroys the tumor through controlled cell death instead of necrosis,
which can harm neighboring cells. IRE can be used to treat kidney, liver, pancreas, and lung tumors, but
new applications are emerging for prostate, eye, and brain tumors. IRE is not expected to replace other
ablative methods for most of these tumor sites because RFA and cryoablation are both faster and cheaper,
and there is little evidence to suggest the clinical superiority of IRE; however, treatment of pancreatic cancer
is a more promising potential use for IRE because other ablative methods are not recommended to treat it.
HCPCS Description2019
Rate
2020
Rate
Percent
change
47382
Percute
ablate liver
RF2
$4596 $4833 5%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOP ablation volumes3
Who should invest?
Currently, only AMCs and large research organizations, especially those with high pancreatic cancer
volumes, should invest in IRE. Considering the system’s high investment cost and lack of evidence
showing clinical superiority over other ablative methods, IRE is not a worthwhile investment for
community cancer programs at this time.
Interventional oncology
12K
16K
4K 4K
3K4K
2018 2023
+34%
Radiofrequency
tumor ablation -
liver
+23% Cryosurgical
tumor ablation -
liver
+11% Tumor
ablation (Cryo/RF) -
Kidney
advisory.com29© 2020 Advisory Board • All rights reserved
2018 2023
Magnetic Resonance-guided Focused Ultrasound SurgeryPalliative treatment is good investment for centers with high volumes of bone
cancer patients
1. Hospital Outpatient Prospective Payment System.
2. Volumes
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Magnetic resonance-guided focused ultrasound surgery (MRgFUS) is a non-invasive treatment used to
thermally destroy target tissue while sparing surrounding tissues and organs. MR imaging visualizes bone
metastasis or tumor margins and allows for real-time monitoring of focused ultrasound sonication. High-intensity
focused ultrasound pinpoints a specific target and is able to raise temperatures high enough to destroy that
tissue. MRgFUS is largely used for pain palliation for metastatic bone cancer, as it ablates the nerves at the
outermost layer of the affected bone, which causes nerve denervation and subsequent pain relief.
Adoption status: Progressive; around 20 U.S. sites currently offer MRgFUS
FDA status: Approved to treat cancer in 2012
Payer coverage: Medicare coverage of MRgFUS offered in select states; covered by some private payers
for pain palliation of metastatic bone cancer
Competing products: High-dose rate brachytherapy (HDR-B), low-dose rate brachytherapy (LDR-B),
external beam radiation therapy (EBRT), surgery
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
C9734
Focused ultrasound
ablation/therapeutic
intervention, other than
uterine leiomyomata, with
MR guidance
$10,714 $11,899 11.1%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology radiation therapy volumes
Who should invest?
Interventional oncology
Clinical considerations: The noninvasive nature of MRgFUS allows for minimal pain, and it is considered
a conservative treatment as it does not use ionizing radiation. MRgFUS is primarily used as a palliative
treatment for pain from bone metastases, although it is being investigated as a curative treatment of
prostate, breast, kidney, lung, and desmoid tumors.
Source: “Magnetic Resonance-Guided Focused Ultrasound (MRgFUS).” Froedtert & the Medical College of
Wisconsin, 11 Mar. 2019, https://www.froedtert.com/mrgfus; Schlesinger, David et al. “MR-guided focused
ultrasound surgery, present and future.” Medical physics vol. 40,8 (2013): 080901. doi:10.1118/1.4811136;
Advisory Board Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
13.0M
14.1M
AMCs and progressive community hospitals should consider investing in MRgFUS technology to stay
competitive. Radiation oncology departments with high volumes of patients suffering from bone metastases
may see highest utilization of the treatment. However, many payers do not yet cover focused ultrasound, and
CMS offers limited coverage, which could lead patients to chose other treatment options.
+8.6%
advisory.com30© 2020 Advisory Board • All rights reserved
Mohs Micrographic Surgery Significant incremental costs may price out centers with low skin cancer volumes
Source: Advisory Board Oncology Market
Estimator; Service Line Strategy Advisor
research and analysis.
1. Hospital Outpatient Prospective Payment System
2. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Mohs Micrographic Surgery (MMS) enables complete tumor resection with less removal of healthy skin and
tissue than traditional surgical excision (TSE) Accordingly, it is most commonly used to treat skin cancers
located in critical and high-visibility areas. The procedure removes individual layers of cancer tissue and
examines them one at a time under a microscope until all cancer tissue has been removed.
FDA status: Approved
Payer coverage: Covered by private payers and Medicare; Medicare generally covers 80% of the cost
Adoption status: Late majority; more commonly performed in dermatologist’s office than by hospital based
programs
Competing products: TSE, radiation therapy for late stage melanoma
Key facts
Clinical considerations: Utilized primarily for non-malignant skin cancers, including basal cell carcinoma
and squamous cell carcinoma, but also for superficial malignant melanoma in some cases; specialists feel
that MMS is not well suited for treatment of melanoma due to its unconnected growth patterns and difficulty
of histologically identifying melanoma in the frozen skin sections used in MMS
HCPCS Description2019
Rate
2020
Rate
Percent
change
17311
Mohs
Micrographic
Technique,
head, neck,
hands, feet,
genitalia, first
stage, up to 5
tissue blocks
$483 $497 3%
17313
Mohs
Micrographic
Technique,
trunk arms
legs, first
stage, up to 5
tissue blocks
$483 $497 3%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology Mohs surgery volumes2
Who should invest?
AMCs, larger community centers, and other organizations with high volumes of non-malignant skin cancer
patients are best positioned to invest in MMS. The significant incremental costs associated with the time
consuming nature of the procedure, the dedicated facility requirements, and the specialized physicians
needed to perform the procedure detract from its attractiveness for community centers with lower volumes.
Interventional oncology
+44%
1.6M
2.3M
2018 2023
advisory.com31© 2020 Advisory Board • All rights reserved
Road map
Medical oncology
advisory.com32© 2020 Advisory Board • All rights reserved
Bone Marrow TransplantationHigh costs and low volumes make investment most attractive for large AMCs
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Bone marrow is a spongy tissue found inside the breast bone, skull, hips, ribs, and spinal column that contains
small amounts of stem cells. Stem cells are rare cells that function as the building blocks for three types of
blood cells —red blood cells, white blood cells, and platelets —and can be replaced to treat a wide variety of
conditions, including leukemia, aplastic anemia, lymphomas, and solid tumor cancers. Patients with an eligible
condition can opt to have their diseased stem cells destroyed and healthy marrow infused into their
bloodstream. If the transplant is successful, the new stem cells will migrate to the cavities of the large bones,
engraft, and begin producing normal blood cells.
Adoption status: Early adopter; over 200 programs have FACT accreditation for transplant, collection, and
processing services
FDA status: Bone marrow transplantation is the only stem cell-based treatment approved by the FDA
Competing products: Chemotherapy, hormonal therapy, NiCord (single ex-vivo expanded cord blood unit
transplantation in patients with hematological malignancies following myeloablative therapy)
Key facts
Financial outlookMedicare IPPS1 reimbursement
Who should invest?
Medical oncology
Clinical considerations: BMT is primarily used to treat hematological malignancies, including some acute
and chronic leukemia, lymphoma, and myeloma
Complex care and regulatory requirements, high volume thresholds, and high startup and ongoing costs
make offering BMT treatment most attractive for AMCs. While these characteristics of BMT have
traditionally been prohibitive for community programs seeking to invest, it has recently become a more
viable option for progressive community cancer programs as outpatient management becomes more
feasible.
MS-DRG /
HCPCSDescription 2019 rate 2020 rate
Percent
change
14 Allogenic BMT $72,962 $79,893 10%
16Autologous BMT
w CC/MCC$39,926 $43,127 8%
17Autologous BMT
w/o CC/MCC$26,749 $27,857 4%
1. Inpatient Prospective Payment System.
2. DRGs representing bone marrow transplantation; 14, 16, 17
3. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
Payer coverage: To consistently obtain full coverage, programs must be identified by either local or national
payers as a BMT Center of Excellence and have a FACT accreditation. Reimbursement typically not
available for outpatient transplants
National market estimatesBone marrow transplantation2 volumes3
19K18K
2018 2023
-8%
advisory.com33© 2020 Advisory Board • All rights reserved
CAR T-Cell TherapyImmunotherapies provide options where none previously existed
1. Hospital Outpatient Prospective Payment System.
2. Incidence is the number of new cases.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Chimeric antigen receptor T-cell (CAR-T) therapy reprograms a patient’s T-cells in a lab so they will attack and
kill cancer cells. T-cells are removed from the patient’s blood, and modified in the lab with a chimeric antigen
receptor. Large numbers of these CAR T-cells are grown in the lab and infused back into the patient.
Adoption status: Early adopter; available at 130 centers around the U.S.
FDA status: First two CAR T-cell therapies approved in 2017
Payer coverage: Medicare will cover 65% of the cost of CAR T-cell therapy when it is provided at healthcare
facilities enrolled in the FDA risk evaluation and mitigation strategies (REMS) for medically-accepted
indications; private payers typically pay separately for the cellular product and then negotiate a case rate
based on the autologous stem cell transplant rate and agree to a percentage of charges all on a case-by-
case basis
Competing products: Chemotherapy, radiation therapy, stem cell transplants, targeted therapies
Key facts
MS-DRG Description 2019 rate 2020 ratePercent
change
Q2041
Axicabtagene
ciloleucel, up to
200mil cells
(Yescarta)
$395,380 $395,380 0%
Q2042Tisagenlecleucel,
up to 600mil cells
(Kymriah)
$489,764 $441,508 -10%
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Medical oncology
Clinical considerations: For aggressive, refractory non-Hodgkin lymphoma and for with relapsed or
refractory acute lymphoblastic leukemia up to age 25, but with more than 50 ongoing trials in solid tumors in
the U.S., more indications are likely. Since CAR T also signals the T-cells to multiply, its effects are
remarkably long lasting for a one-time infusion. Instead of needing six months of chemotherapy, the
reprogrammed T-cells can recognize and attack cancer cells if there is a relapse
With the significant clinical benefit CAR T has been shown to provide, AMCs treating a large number of
complex hematologic cancer patients are best positioned to invest in first generation CAR T pioneers such
as Kymriah and Yescarta. Community cancer centers should wait for a second or third generation of CAR T
drugs to enter the market and either the cost to decrease or reimbursement to increase to match the full cost
of the drug (not to mention the cost of labor and supplies) before considering investing.
Source: Advisory Board Cancer Incidence Estimator;
Service Line Strategy Advisor research and analysis.
National market estimatesIncidence2 of Non-Hodgkin Lymphoma and Leukemias
71K79K
50K 56K
2018 2023
+11.6%
+12.0%
Leukemias
Non-Hodgkin
Lymphoma
advisory.com34© 2020 Advisory Board • All rights reserved
Genetic TestingStrong investment for AMCs or organizations with high breast volumes
Source: US Bureau of Labor Statistics
(https://www.bls.gov/ooh/healthcare/genetic-counselors.htm),
Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Clinical Lab Fee Schedule.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Genetic testing involves the assessment of genetic traits to identify cancer-predisposing mutations, stage and
type tumors, and indicate appropriate targeted therapies based on predicted tumor response. Testing has the
potential to improve care by optimizing disease prevention, diagnosis and therapy selection.
FDA status: Varies; commercial test kits must receive FDA approval before going to market
Payer coverage: CMS covers most tests under Clinical Laboratory Fee Schedule (CLFS), where
national reimbursement limit is set, but payment varies by state. Private payers reimburse genetic testing
on case-by-case basis, though BRCA1 and 2 tests consistently covered. Reimbursement depends upon
ability of tests to garner cost-savings or prevent use of unnecessary therapies
Adoption status: Late majority; 500+ genetic testing clinics in the US, according to the American College of
Medical Genetics. There are ~74,000 genetic testing products(tests, kits) in the US
Competing products: Standard pathology for diagnosis and staging
Key facts
Clinical considerations: Breast, ovarian, and colorectal cancer risk profiling are common
applications; finer disease sub-classification through genetic testing can enable better
prognosis and therapy design, with optimization of clinical outcomes
HCPCS Description2019
rate
2020
rate
Percent
change
81201
Apc gene
full
sequence
$780 $780 -1%
81292
Mlh1 gene
full
sequence
$675 $675 0%
81321
Pten gene
full
sequence
$600 $600 0%
Financial outlookMedicare CLFS1 reimbursement
National market estimatesUS Bureau of Labor Statistics Genetic Counselor Job Outlook
Who should invest?
Highly complex laboratory capability requirements make investing in in-house genetic testing most
suitable for large AMCs, especially those looking to expand market presence via community outreach
programs focused on cancer risk assessment. However, progressive community hospitals that have high
genetic counseling volumes or high breast, ovarian, and colorectal cancer volumes should also consider
developing either in-house or off-site testing as a viable option.
Medical oncology
3K
4K
2018 2023
+27%
advisory.com35© 2020 Advisory Board • All rights reserved
2017 2024
ImmunotherapyGrowth of immunotherapy revenue suggests progressive centers should invest
1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Immunotherapy triggers the immune system to find and destroy cancer. It works by ether stimulating the immune
system to fight cancer or by boosting the immune system with man-made proteins. Therapeutic antibodies are
made in a lab and used to either destroy cancer cells directly or boost the immune response; checkpoint
inhibitors, which prevent cancer cells from halting the immune response prematurely; therapeutic vaccines,
which treat patients who already have cancer; and adoptive cell therapy, which involves taking a patient’s own
T-cells out of their body, growing and activating them in vitro, and reinfusing them back into the patient.
Adoption status: Early adopter; uptake of immunotherapy increasing rapidly
FDA status: Sipuleucel-T (Provenge) became the first FDA-approved immunotherapy in 2010; Yervoy
was approved in 2011; Opdivo and Keytruda were approved in 2014, Kymriah was approved in 2017
Payer coverage: Both Medicare and private payers cover FDA-approved immunotherapy drugs, but some
require prior-authorization
Key facts
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Immunotherapy is a critical offering for AMCs with comprehensive infusion therapy programs. Associated
costs and operational needs make it a less viable investment for the average community cancer center,
but progressive community cancer centers should still consider adoption.
Medical oncology
Clinical considerations: Currently used to treat prostate cancer and melanoma primarily, but research on
use for other cancers in progress; although controversial for high costs, immunotherapy in clinical trials have
better progression-free survival and overall survival rates than regular therapies. Limited to specific subsets
of patients now, but broader potential applications in the future. Patients often experience severe toxicities
with immunotherapies that look different from the traditional side effects of chemotherapy.
Competing products: Gene therapy, targeted therapies
HCPCS Description2019
rate
2020
rate
Percent
change
Q2043Sipuleucel-T (min 50 mil
cells; single infusion)$43,419 $46,374 7%
J9228Ipilimumab injection 10mg
(Yervoy)$151 $153 1.5%
J9271Pembrolizumab injection,
1 mg (Keytruda)$49 $49 0.1%
J9299Nivolumab injection 1mg
(Opdivo)$28 $28 1%
Source: “Global Cancer Immunotherapies Market to 2024 - Increased Uptake of Immune Checkpoint Inhibitors Driving
Growth, Supported by a Large, Robust Pipeline.” Research and Markets - Market Research Reports - Welcome, July 2018,
www.researchandmarkets.com/research/9rpwcx/global_cancer?w=4; Service Line Strategy Advisor research and analysis.
National market estimatesGlobal cancer immunotherapy revenue
$33.7B
$103.4B
+206.8%
advisory.com36© 2020 Advisory Board • All rights reserved
Liquid BiopsyResearch organizations should consider investing in the detection method
1. Clinical Laboratory Fee Schedule.
2. Types of biopsies include lip, skin, thyroid, eat, larynx, nose, tongue, mouth, pharynx, salivary gland, liver, abdomen, bone marrow,
breast, colorectal, lymphatic, gynecologic, upper GI, thoracic, and urologic biopsies.
3. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Liquid biopsies detect cancer from blood samples (or, more rarely, urine and saliva) rather than traditional
tissue samples. They have two applications: detection (to diagnose cancer and monitor disease
progression/recurrence) and molecular profiling (to identify actionable mutations and match patients with
appropriate therapies). There are three potential sources of liquid biopsies, each with its own benefits and
drawbacks: circulating tumor cell (CTC), circulating tumor DNA (ctDNA), and exosomes ejected by tumors.
Adoption status: Progressive; only a handful of liquid biopsies on the market today, as they remain
experimental while the evidence base is still being established
FDA status: Many commercially-available liquid biopsy tests are laboratory-developed tests, and so are
monitored by CMS’ Clinical Laboratory Improvement Amendments (CLIA) and not the FDA
Payer coverage: Not covered by Medicare or private payers beyond standard imaging tests
Key facts
Financial outlookMedicare CLFS1 reimbursement
Who should invest?
Because liquid biopsies are still in the research phase, investment is best suited for progressive
organizations with a focus on innovative cancer research. The low cost of liquid biopsies compared to
traditional biopsies (e.g., $5,800/patient for Guardant360 liquid biopsy vs. $14,000/patient for a lung cancer
tissue biopsy) make it a viable option for both AMCs and research-focused community organizations.
Medical oncology
Clinical considerations: Liquid biopsies are less expensive and minimally invasive, especially compared to
traditional surgical biopsies. They can facilitate earlier detection, particularly in hard-to-detect cancers that
are diagnosed through imaging, and can be performed frequently, which enables clinicians to monitor
treatment response and identify new mutations as the tumor evolves. However, there is mixed evidence that
liquid biopsies are reliable and comparable to traditional biopsies.
Competing products: Standard pathology for diagnosis and staging, screening, genetic testing
HCPCS Description2019
rate
2020
rate
Percent
change
81445Targeted genomic seq
analysis panel, solid organ
neoplasm, 5-50 genes
$598 $598 0%
81450
Targeted genomic seq
analysis panel,
hematolymphoid neoplasm
or disorder, 5-50 genes
$760 $760 0%
Source: NILA USA Final CLFS Payment Rates 2018, 2019, and 2020 (https://www.nila-
usa.org/images/nila/FINAL%20cy_2018_final_private_payor_ratebased_clfs_payment.pdf),
Advisory Board Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
National market estimatesOutpatient oncology biopsy2 volumes3
2018 2023
14.0M
15.9M +13.6%
advisory.com37© 2020 Advisory Board • All rights reserved
Next-Generation SequencingNext-generation sequencing large investment with increased flexibility
Source: “North America Next Generation Sequencing Market”,
https://www.marketdataforecast.com/market-reports/north-america-next-generation-sequencing-market;
Service Line Strategy Advisor research and analysis.1. Clinical Lab Fee Schedule.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Next-generation sequencing (NGS) enables millions or billions of DNA strands to be sequenced in parallel,
yielding significantly higher throughput than traditional technologies. Cheaper and more efficient, it typically
targets the genome (i.e. alterations in the DNA sequence), although some NGS platforms and commercial
panels also look at epigenomics (i.e. changes in gene activity outside of the DNA sequence), and
transcriptiomics (i.e. RNA). Applications in oncology include cancer risk assessments and molecular profiling of
tumors to facilitate treatment decisions.
FDA status: Most NGS panels are lab-developed tests (LDTs), which are monitored by CMS’ CLIA
regulations and not the FDA
Payer coverage: Medicare currently covers NGS tests w/FDA approval as a companion diagnostic and
indication for use in patient’s cancer type for patients with recurrent, metastatic, or advanced-stage
disease; private payer coverage is more varied, with only one-third of managed care organizations
having policies to cover biomarker tests
Adoption status: Early adopter; available at only the most progressive centers
Competing products: Standard pathology for diagnosis and staging, standard genetic testing
Key facts
Clinical considerations: Capable of whole-genome sequencing (examining the entire genome for disease
associations), exome sequencing (exome represents less than 2% of the human genome but contains a
majority of disease-causing mutations), and targeted sequencing (examines a subset of genes or region of
the genome; enables providers to focus on specific areas of interest; can achieve increased accuracy)
CPT Description2019
Rate
2020
Rate
Percent
change
81425
Genome
seq
analysis
$5031 $5031 0%
81426
Genome
seq
analysis
$2710 $2710 0%
Financial outlookMedicare CLFS1 reimbursement
North American market estimatesNext generation sequencing market size(USD)
Who should invest?
With the flexibility to design custom NGS panels and potential revenue associated with NGS, internally
developing a next-generation sequencing lab is a sound decision for AMCs at the forefront of precision
medicine research with high volumes of patients receiving these treatments. With the high upfront costs
associated with developing an internal lab, partnering with an external lab for NGS may be a better option
for community centers despite potentially having to sacrifice flexibility, quality control, and turnaround time.
Medical oncology
1310M
2840M
2019 2024
+117%
advisory.com38© 2020 Advisory Board • All rights reserved
39.8M41.4M
25.3M 26.0M
2.3M 2.6M
2018 2023
Radiomics Decision Support SystemAMCs in personalized cancer medicine space should invest to differentiate
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
The field of radiomics involves the conversion of tumor images to higher-dimensional data and the subsequent
mining of online databases of images, enabling improved decision support and more focused treatment
planning.
Adoption status: Progressive; this is a recently emerging field
FDA status: Not approved; still in research phase and not commercially available yet
Payer coverage: Not covered by Medicare or private payers beyond standard imaging tests
Key facts
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Medical oncology
Clinical considerations: Radiomics could help better classify tumors based on 3D shape, texture, intensity,
wavelet, and other characteristics, which could help predict treatment outcomes. Intra-tumor heterogeneity
challenges treatment and genetic testing efficacy, since different parts of a single tumor may vary wildly;
significant research is still needed before clinical use.
Radiomics could be a potential differentiator for AMCs looking for cutting-edge research opportunities in the
precision medicine space, and first mover advantage could be significant if radiomics proves to be effective.
However, potential investors must ensure they have sufficiently robust data processing and warehousing
capacity or the means to build it out. Also consider the long-term financial impact of reduced volumes due to
more tailored treatment plans.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
National market estimatesOutpatient oncology imaging volumes2
2.8%
Competing products: Genetic testing, PET scans
APC Description 2019 rate 2020 ratePercent
change
5571Level 1 Imaging
with Contrast$202 $182 -10%
5572Level 2 Imaging
with Contrast$386 $382 -1%
5522Level 2 Imaging
w/o Contrast$113 $112 -0.4%
5523Level 3 Imaging
w/o Contrast$231 $233 1%
5593Level 3 Nuclear
Imaging$1229 $1272 4%
5594Level 3 Imaging
w/o Contrast$1376 $1443 5%
3.9%
9.5%
advisory.com39© 2020 Advisory Board • All rights reserved
Targeted Cancer TherapiesLarge number of options allow centers to increase progression-free survival rates
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent unique visits in the outpatient module with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Targeted cancer therapies encompass many classes of infusion and oral chemotherapeutics that specifically
affect tumor cells, including hormone therapies, signal transduction inhibitors, gene expression modulators,
apoptosis inducers, angiogenesis inhibitors, immunotherapies, and toxin delivery molecules. They work by
blocking the growth of cancer by interfering with molecules that control tumor progression. They differ from
traditional chemotherapy because they are able to differentiate normal cells from cancer cells, enabling more
precise treatment with fewer side effects.
FDA status: Tamoxifen, the first targeted cancer therapy drug, was approved in 1990; since then more
than 100 targeted cancer therapy drugs have been approved; in May 2017, pembrolizumab (Keytruda)
became the first drug ever to receive FDA approval for all solid tumors with a specific genetic feature,
regardless of tumor site.Payer coverage: Medicare covers targeted therapies that are FDA-approved and private payers
typically follow suit, but some require prior authorizationAdoption status: Early majority; targeted therapies are available at most cancer centers
Competing products: Standard chemotherapies such as doxorubicin, radiation therapy
Key facts
Clinical considerations: Targeted cancer therapies may be used as adjuvant therapies, first-line therapies,
or last-resort therapies after cancer has progressed. Therapies have significantly increased progression-free
survival for patients with certain cancers over a wide range of tumor sites. However, combinations of
targeted therapies are not always effective, and can result in worse outcomes for some patients
HCPCS Description2019
rate
2020
rate
Percent
change
J9035
Bevacizumab
injection, 10mg
(Avastin)
$79 $81 2%
J9355
Trastuzumab
injection, 10 mg
(Herceptin)
$104 $107 2%
J9271
Pembrolizumab
injection, 1 mg
(Keytruda)
$49 $49 0.1%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology chemotherapy volumes2
Who should invest?
Targeted therapies are increasingly seen as standard of care for both AMCs and community hospitals;
however, AMCs are leading the charge on research and patient accrual for clinical trials for new
targeted therapies. Wide payer coverage and positive patient outcomes make targeted therapies a
good investment for most cancer centers.
Medical oncology
957K979K
2018 2023
+2.3%
advisory.com40© 2020 Advisory Board • All rights reserved
Road map
Radiation oncology
advisory.com41© 2020 Advisory Board • All rights reserved
2018 2023
4D Localization (Calypso)Invest in high-precision therapy if you have high prostate cancer volumes
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Four-dimensional (4D) localization is a technique based on the detection of small electromagnetic markers,
called Beacon transponders, which are implanted in or near a target treatment site. The Calypso system
continuously monitors these markers during radiation delivery in order to detect movements of the prostate and
provide real-time feedback. If the tumor target moves and becomes improperly aligned with the radiation beam,
radiation is stopped until the tumor repositions into the target range.
Adoption status: Progressive
FDA status: Calypso 4D Localization System approved in 2006
Major vendors: Varian (Calypso)
Competing products: Real-time adaptive radiation therapy
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
A4648Tissue marker,
implantable, any typen/a n/a n/a
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesProstate cancer volumes2
Who should invest?
Consider offering treatment with the Calypso 4D Localization System if you see a large number of prostate
cancer patients, as the technology is an expensive investment. The system can be used with stereotactic
body radiation therapy (SBRT) to provide highly accurate radiation treatment, and may be a competitive
differentiator within prostate cancer care.
Radiation oncology
Clinical considerations: Calypso has only been used to treat prostate cancer patients thus far, but
possibility for use to treat lung and other soft tissue cancers in the future
574K
476K
Source: Quigley, Martin M., et al. “Prostate Tumor Alignment and Continuous, Real-Time
Adaptive Radiation Therapy Using Electromagnetic Fiducials: Clinical and Cost-Utility
Analyses.” Urologic Oncology: Seminars and Original Investigations, vol. 27, no. 5, 2009, pp.
473–482. ScienceDirect, doi:https://doi.org/10.1016/j.urolonc.2008.04.017; Advisory Board
Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
-16.9%
advisory.com42© 2020 Advisory Board • All rights reserved
2018 2023
AccuBoost Breast RadiotherapyWise investment for centers with high volumes of early stage breast patients
1. Hospital Outpatient Prospective Payment System.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
AccuBoost is an image-guided radiation therapy technique designed to improve the efficacy of the “boost dose”
irradiation delivered to the tumor cavity of women following lumpectomy. Following breast immobilization,
radiographic images are taken immediately before every treatment fraction. Tungsten applicators are then
placed on the surface of the breast, to deliver high intensity Iridium-192 from a high-dose rate brachytherapy
(HDR-B) after-loader system to the target. Treatment is performed daily over 5-10 days, prior to or after 25
daily whole breast irradiation (WBI) sessions.
Adoption status: Early adopter; utilized at over 50 sites across the U.S.
FDA status: Approved in 2006
Major vendors: Advanced Radiation Therapy
Competing products: scar-guided WBI following lumpectomy
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
19499 Breast surgery procedure $2,816 $3,029 7.6%
77771
Remote afterloading high
dose rate radionuclide
interstitial or intracavitary
brachytherapy, includes basic
dosimetry, when performed;
2-12 channels
$705 $740 5.0%
Financial outlookMedicare HOPPS1 reimbursement
National market estimates
Who should invest?
Radiation oncology
Clinical considerations: AccuBoost breast radiotherapy is used to treat early stage breast cancer. It is
primarily used prior to WBI, and early results suggest it may be safe for accelerated partial breast irradiation.
AccuBoost allows for more precise and accurate delivery than standard methods of scar-guided
identification and delineation of the targeted lumpectomy cavity.
55.7K
66.7K
144K
131K
HDR-B,
breast tumor site
Lumpectomy
AccuBoost is a good investment for organizations with a large number of early-stage breast cancer patients.
The treatment can be a differentiator among comprehensive breast centers, providing patients with a less-
invasive treatment option that can improve both cosmetic and morbidity outcomes.
Source: Advisory Board Oncology Market
Estimator; Service Line Strategy Advisor
research and analysis.
-9.1%
+19.7%
advisory.com43© 2020 Advisory Board • All rights reserved
Carbon Ion TherapyAMCs and research institutions uniquely positioned to invest due to high costs
Source: Bortzfield, B, WJCT “Mayo Clinic To Build North America’s First Carbon Ion Therapy Unit In Jacksonville”,
“https://news.wjct.org/post/mayo-clinic-build-north-americas-first-carbon-ion-therapy-unit-Jacksonville”, Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent unique visits for patients with a primary diagnosis of cancer. For radiation
therapy, each visit represents a treatment or fraction, not a whole course of therapy.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Carbon ion therapy directs particularly heavy charged carbon nuclei at a tumor, irradiating and destroying the
cells. Similar to proton therapy, which uses the charged nuclei of hydrogen atoms, this is in contrast to
traditional radiation therapy carried out with much lighter photons.
FDA status: Not approved; Mayo plans to work closely with Hitachi, who makes the equipment, to gain
approval through research
Payer coverage: Treatment is not covered by Medicare or private payers in the US
Adoption status: While there are 13 carbon ion centers worldwide already serving 22,000 patients, there
are currently no sites performing carbon ion therapy in the US; the Mayo Clinic is currently building the first
carbon ion therapy treatment facility in the US, expected to be completed in 2023
Competing products: Drug therapy, surgery, traditional radiation therapy, proton therapy
Key facts
Clinical considerations: Carbon ion therapy is similarly precise to proton therapy, but as carbon ions are
heavier, they deliver more power than protons do. Accelerated particles deliver their energy in a delayed
burst, so that very little damage occurs to normal tissue as the beam enters the body and power is
concentrated at the tumor where the particle track stops. Carbon centers abroad have reported high survival
rates post treatment for a variety of tumor sites (including head and neck, lung, GI, etc.) but it is particularly
effective for hard-to-treat bone and soft-tissue cancers such as spinal tumors.
HCPCS Description2019
rate
2020
rate
Percent
change
77520
Proton trmt
simple w/o
comp
$520 $539 4%
77522
Proton trmt
simple w/
comp
$1,079 $1,247 16%
77525Proton trmt
complex$1,079 $1,247 16%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient proton beam treatment volumes2
Who should invest?
AMCs and research institutions are best suited to establish carbon ion centers. The $300 million price
tag of establishing such a center will price out community centers for years to come. Since there is
currently no coverage for this treatment, cancer centers with large populations of patients who can pay
out of pocket will be uniquely positioned to take advantage of this niche treatment.
Radiation oncology
233K
267K
2018 2023
+14.7%
advisory.com44© 2020 Advisory Board • All rights reserved
CT SimulationDedicated simulator good investment for high-volume RT departments
1. Hospital Outpatient Prospective Payment System,.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
CT simulation uses a CT scanner to acquire 3D images of a tumor and surrounding anatomy that allows
providers to accurately plan for radiation therapy (RT). CT simulators include a CT scanner (usually 4- or 16-
slice), orthogonal wall or ceiling-mounted lasers for patient localization, and a simulation software to render the
CT slices as a 3D image, used to localize the tumor and plan the RT treatment.
Adoption status: Conservative; hundreds of institutions within the U.S. use CT simulations
FDA status: Various approved devices on the market
Major vendors: GE, Philips, Siemens, Toshiba
Competing products: Conventional two-dimensional (2D) simulation with kV x-rays
Key facts
APC Description2019
rate
2020
rate
Percent
change
5611
Level 1 Therapeutic
Radiation Treatment
Preparation: Set Radiation
Therapy Field
$124 $127 2.4%
5612
Level 2 Therapeutic
Radiation Treatment
Preparation: Set Radiation
Therapy Field
$322 $335 4.0%
5613
Level 3 Therapeutic
Radiation Treatment
Preparation: 3D
Radiotherapy Plan
$1,192 $1,245 4.4%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesExternal beam radiation therapy volumes2
Who should invest?
Radiation oncology
Clinical considerations: CT simulation enables more dynamic visualization of the target and, thus, more
accurate placement of radiation beams and more conformal treatment as compared to conventional
simulation with 2D x-ray images
CT simulators are a viable investment for all organizations offering radiation therapy treatment, as CT
simulation is considered “standard of care”. However, investment in a dedicated CT simulator for the
radiation therapy department is best suited for organizations experiencing or anticipating capacity
constraints on CT scanners currently used for simulation; the increasing use of 3D and 4D CT for
dosimetry is also likely to justify investment in a dedicated CT simulator.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
2018 2023
5.6M
7.1M
46K 63K
6.7M
6.2M
IMRT
SBRT
21.3K 21.4K
+26.1%
-6.9%
+37.4%
+0.5%
SRS
advisory.com45© 2020 Advisory Board • All rights reserved
2018 2023
High-Dose Rate BrachytherapyHDR-B is a standard care offering for a comprehensive cancer center
Source: “New Clinical Brachytherapy Codes in 2016.” AAPC Knowledge
Center, 7 Mar. 2016, https://www.aapc.com/blog/33907-new-clinical-
brachytherapy-codes-in-2016/; Advisory Board Oncology Market
Estimator; Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
High-dose rate brachytherapy (HDR-B) delivers radiation through catheters and applicators implanted directly
into the tumor site or tumor bed. Catheters (interstitial) or applicators (intracavitary) are inserted into the
treatment site. After treatment planning, the applicators are connected with wires to a remote afterloader, which
delivers the radioactive sources to the tumor sites.
Adoption status: Late majority; approximately 1,000 sites in the U.S.
FDA status: Nucletron microSelectron approved in 2004; Nucletron Flexitron approved in 2007; Varian
GammaMedplus and Varisource approved in 2007
Major vendors: Nucletron (acquired by Elekta in 2011); Varian Medical Systems
Competing products: External beam radiation therapy, surgery, low-dose rate brachytherapy (LDR-B)
Key facts
HCPCS Description 2019 rate 2020 ratePercent
change
0394THDR electronic
skin surface
brachytherapy
$224 $236 5.4%
77770,
77771,
77772
Remote
afterloading high
dose rate
radionuclide
interstitial or
intracavitary
brachytherapy
$705 $740 5.0%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient high-dose rate brachytherapy volumes2
Who should invest?
Although the use of HDR-B has declined substantially over the last decade as sophisticated (and better
reimbursed) surgical techniques and EBRT technologies have gained popularity, brachytherapy’s clinical
efficacy is well established, and the technology is essential for all comprehensive cancer centers.
Radiation oncology
Clinical considerations: Primarily used to treat prostate, gynecologic, breast, head and neck, and
esophageal cancers. HDR-B can be used not only as a supplement to surgery, but also as a standalone
therapy.
364K
304K
+19.7%
advisory.com46© 2020 Advisory Board • All rights reserved
Image-Guided Radiation TherapyIGRT considered standard of care treatment offering
Source: Zelefsky et al., “Improved Clinical Outcomes with High–Dose Image Guided Radiotherapy Compared
with Non-IGRT for the Treatment of Clinically Localized Prostate Cancer,”Int J of Rad Onc. Biol. Phys. 2012
Simpson et al., “A Survey of Image-Guided Radiation Therapy Use In The United States,” Cancer, 2010;
Advisory Board Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Image-guided radiation therapy (IGRT) involves systematically (often daily) imaging the patient on the
treatment table immediately prior to treatment delivery, in order to verify tumor location. Conventional IGRT
includes planar imaging and volumetric imaging; IGRT may be practiced with an array of imaging modalities,
including cone-beam CT, stereoscopic kV X-rays, MV port films, and fluoroscopy; it also may be used with
IMRT or 3D CRT.
Adoption status: Late majority; over 90% of RT programs in the U.S. use IGRT
FDA status: Multiple FDA-approved devices on the market
Major vendors: BrainLAB, Elekta, Siemens, TomoTherapy, Varian, ViewRay
Competing products: Three-dimensional conformal radiation therapy (3D CRT), intensity-modulated
radiation therapy (IMRT)
Key facts
APC Description 2019 rate 2020 ratePercent
change
5621Level 1 Radiation
Therapy$117 $123 5.1%
5622Level 2 Radiation
Therapy$224 $236 5.4%
5623Level 3 Radiation
Therapy$520 $539 3.7%
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Radiation oncology
Clinical considerations: Particularly effective for prostate, lung, head and neck lesions; confirms patient
and tumor position and enables treatment modification prior to RT. IGRT technology must be combined
with consistent high-quality treatment planning and delivery procedures in order to achieve superior results.
IGRT is a necessary investment for any facility offering radiation therapy as a treatment option, as it is
considered “standard of care”.
2018 2023
National market estimatesOutpatient oncology radiation therapy volumes2
13.0M
14.1M
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
+8.6%
advisory.com47© 2020 Advisory Board • All rights reserved
2018 2023
5.6M
Intensity-Modulated Radiation TherapyIMRT widely regarded as standard offering for comprehensive cancer programs
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Intensity-modulated radiation therapy (IMRT) technology utilizes inverse treatment planning software and a
multileaf collimator (MLC) to produce a more optimal dose delivery plan and conformal radiation beam. Inverse
treatment planning uses a computer algorithm to calculate beam angles and doses for a given target. The MLC
is used to generate a beam according to the optimized treatment plan, creating a more conformal dose
distribution.
Adoption status: Late majority; clinical use of IMRT is widespread
Major vendors: LINAC technologies: Accuray, Elekta, Varian
Treatment planning software: Brainlab, ViewRay
Key facts
HCPCS Description 2019 rate 2020 ratePercent
change
77338 MLC device for IMRT $322 $335 4.0%
77385Ntsty modul rad tx dlvr
simple$520 $539 3.7%
77386Ntsty modul rad tx dlvr
complex$520 $539 3.7%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology IMRT volumes2
Who should invest?
Radiation oncology
IMRT is considered a standard offering for AMCs and community hospitals alike. Any institution hoping to boast
a comprehensive cancer center should invest in IMRT technology in order to be competitive.
Competing products: Three-dimensional conformal radiation therapy (3D CRT), image-guided radiation
therapy (IGRT)
FDA status: First IMRT system approved in the 1990s
7.1M
Clinical considerations: Allows for higher and more effective doses, reduced side effects, and improved
treatment outcomes over 3D CRT. Most commonly used in treating prostate, head and neck, and central
nervous system tumors; in limited situations, also used to treat breast, thyroid, lung, gastrointestinal, and
genitourinary tumors
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
+26.1%
advisory.com48© 2020 Advisory Board • All rights reserved
2018 2023
Intraoperative Radiation TherapyInvest in IORT if you have high volumes of breast cancer patients
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Intraoperative radiation therapy (IORT) is the delivery of radiation directly to the tumor site during surgery.
IORT can be delivered via miniaturized or self-shielded platforms in the operating room, or by patient transport
to a shielded vault. During surgery, a radiation delivery platform, such as a LINAC or high-dose rate (HDR)
afterloader, is attached to an applicator to guide radiation delivery. The applicator is directed to the exposed
tumor bed while the surrounding tissue is shielded, allowing delivery of high-dose radiation.
Adoption status: Early adopter; 17 U.S. sites using Mobetron, ~50 sites using Intrabeam, 10-20 centers
using HDR IORT
FDA status: Mobetron approved in 1998, Intrabeam in 2005, Xoft electronic brachytherapy in 2009
Major vendors: IntraOp Medical Corporation (Mobetron), Carl Zeiss Meditech AG (Intrabeam), iCAD Inc.
Competing products: Whole breast irradiation (WBI), surgery, external beam radiation therapy (EBRT),
brachytherapy
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
77424Intraoperative radiation
treatment delivery, x-ray$7,644 $7,942 3.9%
77425Intraoperative radiation
treatment delivery,
electrons
$7,644 $7,942 3.9%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient lumpectomy volumes2
Who should invest?
Radiation oncology
Clinical considerations: IORT enables delivery of a higher dose, since the radiation does not need to pass
through surrounding structures. IORT is primarily used for breast cancer; also some use for gastric, head &
neck, rectal, prostate, and skin cancers
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
144K
131K
IORT is a suitable investment for organizations with comprehensive cancer programs seeking to offer
advanced radiation therapy treatment options, especially those that have a high volume of breast cancer
patients. Given IORT’s ability to potentially shorten the course of treatment, it could be an especially
attractive investment opportunity for programs looking to increase throughput and capacity. However, the
additional staffing costs associated with the fact that the procedure requires both radiation oncologist and
surgeon involvement may be prohibitive for some organizations.
-9.1%
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
advisory.com49© 2020 Advisory Board • All rights reserved
2018 2023
Low-Dose Rate BrachytherapyGood investment for programs with high prostate cancer patient volumes
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Low-dose rate brachytherapy (LDR-B) involves the permanent placement of small radioactive “seeds” which
irradiate the entire tumor from within while minimizing radiation exposure to surrounding healthy tissue.
Typically, a computer-generated plan is used to calculate the optimal seed placement configuration and dose
distribution. Needles are then inserted into the tumor site using ultrasound guidance, through which the seeds
are deposited through the needles and immediately begin delivering radiation.
Adoption status: Conservative; LDR-B is a widely-accepted first-line treatment for early stage prostate
cancer
FDA status: Major contemporary products received approval in early 2000s
Major vendors: IsoRay Medical, Inc., MDS Nordion, Oncura Brachytherapy, Theragenics Corporation
Key facts
HCPCS Description 2019 rate 2020 ratePercent
change
77789Surface application
of low dose rate
radionuclide
$117 $123 5.1%
77763
Intracavitary
radiation source
application;
complex
$704 $740 5.1%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient low-dose rate brachytherapy volumes2
Who should invest?
Radiation oncology
69K
60K
LDR-B is a sound investment for AMCs and community hospitals with high volumes of prostate cancer
patients, as both patients and clinicians often prefer LDR-B over EBRT due to its minimally invasive nature,
short treatment time, and superior dose conformity.
-12.9%
Competing products: External beam radiation therapy (EBRT), surgery, high-dose rate brachytherapy
(HDR-B), electronic brachytherapy
Clinical considerations: Primarily utilized for treatment of prostate cancer, but some use for lung, head
and neck, breast, cervix, and liver cancers; also used to treat resected brain metastases. LDR-B is often
used in concert with surgery.
advisory.com50© 2020 Advisory Board • All rights reserved
2018 2023
Magnetic Resonance Image Guided-Radiation TherapyLarge investment in high precision therapy suitable for progressive centers
Source: Simpson et al., “A Survey of Image-Guided Radiation Therapy Use In The United States,” Cancer, 2010. Elekta. Elekta Unity, 2020,
https://www.elekta.com/radiotherapy/treatment-delivery-systems/unity/. “Mridian Locator - ViewRay - MRIdian MRI-Guided Linac.” ViewRay,
2018, https://viewray.com/mridian-locator/; Advisory Board Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Magnetic resonance image (MRI)-guided radiation therapy is a newer, more precise form of image-guided
radiation therapy (IGRT). The system combines MRI technology with either a cobalt-60 or linear accelerator
radiation therapy machine; the captured images of anatomical structures can be used to improve the precision
and accuracy of the radiation beam and conduct in-the-moment changes to the treatment plan. MRI-guided
radiation therapy is advantageous because it creates images of anatomical structures without exposing
patients to additional radiation, so patients can be imaged more frequently. Additionally, MRI produces images
with greater detail than conventional imaging.
Adoption status: Progressive; ViewRay technology currently offered at 15 sites across the US, Elekta Unity
offered at 3 centers in the US and for research purposes in Europe
FDA status: ViewRay MRIdian MRI-Guided LINAC approved in 2017, Elekta Unity MR-LINAC approved in
2018
Competing products: Conventional IGRT, three-dimensional conformal radiation therapy (3D CRT),
intensity-modulated radiation therapy (IMRT), real-time adaptive radiation therapy
Key facts
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology radiation therapy volumes3
Who should invest?
Radiation oncology
Clinical considerations: Greatest impact for tumor sites where anatomy is most complicated or dynamic,
such as abdomen, head and neck, lung, brain, and sites near soft tissue; produces images of actual
anatomy, not surrogates, with no additional radiation dose, confirms patient and tumor position, and enables
treatment modification prior to radiation therapy
13.0M
14.1M
Given the high cost and unproven clinical superiority, MRI-guided radiation therapy is an investment best
suited for progressive cancer programs seeking to use it for research or to differentiate themselves in a
competitive market. This technology may also be particularly attractive to cancer programs receiving or
preparing for value-based payment, as it has the potential to reduce the total of care by providing radiation
in a fewer number of fractions and reducing side effects by decreasing irradiation of normal tissue.
HCPCS Description2019
rate
2020
rate
Percent
change
77402 Radiation treatment delivery $117 $123 5.1%
77407, 77412 Radiation treatment delivery $224 $236 5.4%
773872
Guidance for localization of
target volume for delivery of
radiation treatment delivery
n/a n/a n/a
1. Hospital Outpatient Prospective Payment System.
2. Not separately reimbursable but should be reported for tracking purposes.
3. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
+8.6%
advisory.com51© 2020 Advisory Board • All rights reserved
Multi-Functional Linear Accelerator (LINAC)
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Multi-functional LINAC (MFL) platforms are optimized for the treatment of intra- and extracranial lesions with
stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT), respectively, as well as
conventional and intensity-modulated therapy (IMRT) treatments. MFLs utilize a variety of integrated image-
guidance systems, including stereoscopic kV X-ray, MV X-ray, and cone-beam CT, in addition to high
resolution beam shaping capabilities and stereotactic coordinate-based tumor localization, to enable delivery of
single- and hypo-fractionated treatments to lesions located in close proximity to critical structures.
Adoption status: Early majority
FDA status: First MFL platforms approved in 2000s
Competing products: Three dimensional conformal radiation therapy (3D CRT), intensity-modulated
radiation therapy (IMRT), image-guided radiation therapy (IGRT), SRS/SBRT on other platforms
Key facts
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Multi-functional LINAC platforms are increasingly viewed as a competitive imperative to retain a range of oncology
patients. Radiosurgery offerings typically require additional staff training, and investment in the technology should
follow neurosurgeon and radiation oncologist buy-in for performing SRS and SBRT on the platform. It is important
to evaluate the size of regional and local RT market, especially for SRS- and SBRT-eligible patient volumes, before
investing.
Radiation oncology
Invest in multi-functional LINAC platforms for range of advanced RT capabilities
APC Description 2019 rate 2020 ratePercent
change
5621Level 1
Radiation Therapy$117 $123 5.1%
5622Level 2
Radiation Therapy$224 $236 5.4%
5623Level 3
Radiation Therapy$520 $539 3.7%
5626Level 6
Radiation Therapy$1,691 $1,768 4.6%
5627Level 7
Radiation Therapy$7,644 $7,942 3.9%
National market estimatesExternal beam radiation therapy volumes2
Clinical considerations: MFL combines advanced imaging, highly accurate beam collimation, motion
management, and (typically) robotic patient positioning in a single, flexible platform
2018 2023
5.6M
7.1M
46K63K
6.7M
6.2M
IMRT
SBRT
21.3K21.4K
+26.1%
-6.9%
+37.4%
+0.5%
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
SRS
3D CRT
Major vendors: Varian (TrueBeam), Elekta (Infinity), Siemens (Oncor)
advisory.com52© 2020 Advisory Board • All rights reserved
2018 2023
Proton Beam TherapyLarge investment, due to high costs, more suitable for AMCs
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis. This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Proton beam therapy (PBT) is an external beam radiation treatment that delivers protons (as opposed to
electrons or photons) to a precise target in the body. A particle accelerator is used to manipulate a beam of
protons. The maximum energy dose is released at an adjustable depth in the body, achieved by varying the
speed of the particles.
Adoption status: Progressive; 30 centers currently operating in the U.S.
FDA status: Only certain large-scale and single-room models FDA approved at this time
Major vendors: IBA; Hitachi; Mevion Medical; Mitsubishi Electric; Optivus; Protom International; Varian;
Sumitomo Heavy Industries; CPAC
Competing products: Conventional radiation therapy, surgery, intensity-modulated radiation therapy,
(IMRT), image-guided radiation therapy (IGRT), stereotactic radiosurgery (SRS)/stereotactic body radiation
therapy (SBRT)
Key facts
HCPCS Description 2019 rate 2020 ratePercent
change
77520Proton trmt
simple w/o comp$520 $539 3.7%
77522Proton trmt
simple w/comp$1,079 $1,247 15.6%
77523Proton trmt
intermediate$1,079 $1,247 15.6%
77525Proton trmt
complex$1,079 $1,247 15.6%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology proton beam therapy volumes2
Who should invest?
AMCs are generally the best candidates for proton therapy investment due to the technology’s high cost,
though the advent of smaller scale models may make it more accessible to a broader market, including
community hospitals.
Radiation oncology
Clinical considerations: Recognized for equivalence or superiority to conventional radiation therapy in
treatment of pediatric, prostate, ocular tumors and skull-based chordomas
233K
267K +14.7%
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
advisory.com53© 2020 Advisory Board • All rights reserved
Radiosensitivity TestingProgressive AMCs focused on personalized medicine should invest
Source: Advisory Board Oncology Market Estimator; Service
Line Strategy Advisor research and analysis.This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Radiosensitivity testing is a new approach to improving the effectiveness of radiation therapy while reducing
toxicity. It identifies genetic markers that provide information about how tumors are likely to respond to
radiation, using multi-gene expression assays. That information can then be used to calculate a radiosensitivity
index (RSI) to determine whether a particular patient is likely to benefit from radiation therapy, and, if so, refine
the treatment plan accordingly. The RSI score is used to identify the optimal radiation dose for a patient’s
specific tumor; a low RSI score indicates tumor cell is radiosensitive (i.e., unlikely to survive radiation therapy).
Adoption status: Progressive
FDA status: Not yet FDA approved; assays still in research and development phase
Key facts
HCPCS2 Description 2019 rate 2020 ratePercent
change
81201Apc gene full
sequence$780 $780 -1%
81292Mlh1 gene
full sequence$675 $675 0%
81321Pten gene
full sequence$600 $600 0%
Financial outlookMedicare CLFS1 reimbursement
Who should invest?
Radiosensitivity testing could be a clinical differentiator for AMCs. Although the test is still in development,
progressive institutions interested in innovative research possibilities within precision medicine should
consider from investing in the technology. This test may also be an appealing investment for institutions
receiving or preparing for value-based payment that are looking for innovative ways to reduce costs
associated with unnecessary care utilization and improve outcomes.
Radiation oncology
Clinical considerations: The assay has been used to identify stage 2-3 rectal cancer patients who will not
benefit from pre-operative chemoradiation. Research shows promise for use in head & neck, non-small-cell
lung, and breast cancers, as well.
2018 2023
National market estimatesOutpatient oncology radiation therapy volumes3
13.0M
14.1M
Major vendors: Cvergenx
+8.6%
1. Clinical Laboratory Fee Scheduling.
2. Reimbursement codes not specifically for radiosensitivity testing, but may give an idea of what those codes may look like in the future.
3. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
Payer coverage: Currently only covered for clinical trial patients
advisory.com54© 2020 Advisory Board • All rights reserved
Real-Time Adaptive Radiation TherapyRelatively small invest to upgrade systems for centers currently offering IGRT
Sources: Simpson et al., “A Survey of Image-Guided Radiation Therapy Use In The United States,” Cancer, 2010.,
“Accuray Precision® Treatment Planning.” Accuray, Precise, Innovative Tumor Treatments | Accuray, 28 May 2019,
https://www.accuray.com/software/precision-treatment-planning/; Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Real-time adaptive radiation therapy is an advanced form of image-guided radiation therapy (IGRT). The goal
is to adjust the radiation beam in response to small movements in the patient created by breathing or digestion.
The system’s software uses information produced by beacons implanted near the tumor to re-shape the beam.
Real-time adaptive software translates tumor motion into beam motion, and the result is a radiation beam that
changes shape with the tumor.
Adoption status: Progressive; still in research and development phase, but expected to become more
widely available within next few years
FDA status: Accuray software approved in 2016
Major vendors: Accuray (PreciseART software)
Key facts
Who should invest?
Radiation oncology
Clinical considerations: Greatest potential impact for tumor sites where anatomy is most complicated or
dynamic, such as prostate, abdomen, head and neck, lung, brain, and sites near soft tissue.
Any cancer program that already has IGRT should consider investing in real-time adaptive radiation
therapy, as it only requires a relatively low-cost software upgrade from conventional IGRT.
HCPCS Description 2019 rate 2020 ratePercent
change
77402Radiation
treatment delivery$117 $123 5.1%
77407,
77412Radiation
treatment delivery$224 $236 5.4%
Competing products: MRI-guided radiation therapy
2018 2023
National market estimatesOutpatient oncology radiation therapy volumes2
13.0M
14.1M +8.6%
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
Financial outlookMedicare HOPPS1 reimbursement
advisory.com55© 2020 Advisory Board • All rights reserved
2018 2023
Respiratory GatingSignificant clinical results justify relatively small investment for GI tumor programs
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Respiratory gating uses computer software to guide the delivery of radiation as a patient breathes. Respiratory
movements can sometimes shift tumor location, especially if located in the lungs, chest, or abdomen.
Respiratory gating works either through the use of external devices to predict or control the patient’s breathing,
or through specialized software, which allows radiation oncologists to define a treatment field and then deliver
radiation only when the tumor passes through the defined region. Four-dimensional CT simulation is used to
determine tumor motion.
Adoption status: Progressive
FDA status: Real-time Position Management system from Varian approved in 2000s, Anzai system from
Siemens approved in 2019
Major vendors: Varian (Real-time Position Management), Siemens (Anzai), Elekta (Active Breathing
Coordinator), Dyn’R (SDX System)
Competing products: Real-time adaptive radiation therapy, deep inspiration breath hold technique
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
77387Guidance for radiation
treatment deliveryn/a n/a n/a
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Respiratory gating technology is a worthwhile investment for cancer programs with high volumes of lung,
stomach, pancreas, and liver cancer patients. However, each program will need to carefully weigh the
clinical benefits against the costs when deciding between investing in relatively low-cost respiratory gating
software that can be added to current radiation therapy platforms and higher-cost respiratory gating devices.
Radiation oncology
Clinical considerations: Shown to be most effective for tumors located in regions such as the lungs,
stomach, pancreas, and liver.
Source: Giraud, Philippe, and Annie Houle. “Respiratory Gating for Radiotherapy:
Main Technical Aspects and Clinical Benefits.” ISRN Pulmonology, vol. 2013, Jan.
2013, pp. 1–13., doi:10.1155/2013/519602; Advisory Board Oncology Market
Estimator; Service Line Strategy Advisor research and analysis.
National market estimatesOutpatient oncology radiation therapy volumes2
+8.6%
13.0M
14.1M
advisory.com56© 2020 Advisory Board • All rights reserved
2018 2023
Single-Room Proton Beam TherapySmaller-scale models may allow more community hospitals to offer PBT
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Single-room proton beam therapy (PBT) systems are compact, single-vault solutions for radiation that deliver
protons to a precise target in the body. Like the original multi-room proton therapy systems, a particle
accelerator is used to manipulate a beam of protons. The speed of the particles can be varied to deliver a
maximum energy dose at a specific depth in the body.
Adoption status: Progressive; offered at over 300 different sites around the U.S.
FDA status: Multiple devices approved, beginning in 2014
Major vendors: IBA (ProteusONE), Mevion Medical (S250), Varian (ProBeam), ProTom (Radiance 330)
Competing products: Chemotherapy, surgery, conventional radiation therapy, intensity-modulated
radiation therapy (IMRT), image-guided radiation therapy (IGRT), three-dimensional conformal radiation
therapy (3D CRT), stereotactic radiosurgery (SRS), stereotactic body radiation therapy (SBRT), multi-room
proton bream therapy systems
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
77522Proton treatment, simple
with compensation$1,079 $1,247 15.6%
77523Proton treatment,
intermediate$1,079 $1,247 15.6%
77525Proton treatment,
complex$1,079 $1,247 15.6%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient proton beam therapy volumes2
Who should invest?
Radiation oncology
Clinical considerations: Recognized for equivalence or superiority to conventional radiation therapy in
treatment of pediatric, prostate, ocular tumors and skull-based chordomas. Clinical trials for additional sites
are emerging and ongoing. The perceived benefits of PBT over conventional RT spurred clinical interest,
despite the lack of long-tem clinical studies
233K
267K
Although single-room proton beam therapy is still an investment best suited for AMCs, it’s lower cost
compared to multi-room proton beam therapy also makes it a viable option for progressive community
centers that see high volumes of patients eligible for this treatment. However, community centers evaluating
this technology should be sure to consider the specially trained clinical and physics staff required to operate
the technology as part of the investment cost.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
+14.7%
advisory.com57© 2020 Advisory Board • All rights reserved
2018 2023
SpaceOAR HydrogelCenters treating high numbers of prostate cancer patients should invest
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
SpaceOAR Hydrogel minimizes rectal injury in men receiving radiation therapy for prostate cancer that is not
locally advanced. The spacer pushes the rectum away from the prostate, moving it out of the region affected by
high-dose radiation and thus preventing any damage to the cells in the rectum. Implantation of the spacer
should be done before the start of radiation treatment, and can be used with all types of radiation therapy,
including external beam radiation therapy (EBRT), brachytherapy, stereotactic body radiation therapy (SBRT),
and proton beam therapy. Hydrogel remains in the body for around 3 months and is then absorbed and cleared
in the patient’s urine within 6 months.
Adoption status: Early adopter
FDA status: Approved in 2015
Major vendors: Boston Scientific
Payer coverage: Widely covered by most private payers
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
55874
Transperineal
placement of
biodegradable material,
peri-prostatic, single or
multiple injection(s),
including image
guidance, when
performed
$4,020 $4,231 5.2%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesRadiation therapy volumes2 for prostate cancer patients
Who should invest?
Radiation oncology
Clinical considerations: SpaceOAR Hydrogel has been found to have multiple benefits for patients,
including reduced rectal toxicity rates, preserved sexual function post-treatment, and overall improved long-
term quality of life.
Comprehensive cancer programs that treat high volumes of prostate cancer patients should consider
investing in SpaceOAR Hydrogel. The many patient benefits give it the potential to be an effective
differentiator for prostate cancer centers of excellence in highly competitive markets.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
3.4M
3.9M +15.4%
advisory.com58© 2020 Advisory Board • All rights reserved
2018 2023
Stereotactic Body Radiation TherapyEnsuring physician support, identifying referral sources imperative for investment
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Stereotactic body radiation therapy (SBRT) involves the precise delivery of a high dose of ionizing radiation
over a few delivery sessions to a localized malignancy, in order to kill tumor cells and prevent future growth.
The therapy is most commonly delivered via use of a linear accelerator. Through the use of three-dimensional
coordinate-based treatment planning and dose delivery, a specific area encompassing the tumor receives high
dose radiation from multiple beams.
Adoption status: Early majority; offered at over 300 different sites around the U.S.
FDA status: Approved in the 2000s for major manufacturers
Major vendors: Accuray, BrainLAB, Elekta, Siemens, Varian
Competing products: Intensity-modulated radiation therapy (IMRT), three-dimensional conformal radiation
therapy (3D CRT)
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
77290 Set radiation field $322 $335 4.0%
77295 3-d radiotherapy plan $1,192 $1,245 4.4%
77373 SBRT delivery $1,691 $1,768 4.6%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology SBRT volumes2
Who should invest?
Radiation oncology
Clinical considerations: Typically used to treat early-stage non-small cell lung tumors; other investigative
sites include small-to-medium size tumors in prostate, liver, abdomen, and spine. There is emerging clinical
evidence of effectiveness over competing modalities, though long-term studies are ongoing. SBRT may
attract referrals for patients with complex tumors or those who are poor candidates for surgery.
45.9K
63.0K
SBRT is still a worthwhile investment for AMCs treating complex tumor sites looking to differentiate
themselves in a competitive market. As clinical evidence of the benefits of SBRT grows, SBRT is becoming
the new normal at progressive AMCs. The number of private practices starting to use SBRT is also
increasing. Having a dedicated multidisciplinary team of radiation oncologists, other specialists, and
dosimetry support to manage SBRT utilization is an important key for investment success.
+37.4%
advisory.com59© 2020 Advisory Board • All rights reserved
2018 2023
Stereotactic RadiosurgeryDedicated SRS system suited for strong brain tumor programs
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Stereotactic radiosurgery (SRS) involves the highly precise, 3D coordinate-based delivery of high-intensity
ionizing radiation to destroy malignant and benign intracranial tumors. SRS can be delivered by a variety of
radiation therapy machines, from a dedicated cobalt-based device — the Gamma Knife — to LINAC-based
platforms. A 3D coordinate-based localization and treatment planning system enables accurate tumor
localization and delivery of high-dose radiation to the tumor with minimal dose to surrounding tissues.
Adoption status: Early majority; over 110 Gamma Knife units and over 2,000 multifunctional LINAC
sites in the U.S.
FDA status: Numerous devices approved by FDA, since the 1980s
Major vendors: Accuray (CyberKnife), Elekta (Leksell GammaKnife) , Varian (Edge, HyperArc)
Competing products: Surgical resection, whole-brain radiation
Key facts
HCPCS Description 2019 rate 2020 ratePercent
change
77371SRS,
multisource$7,644 $7,941 3.9%
77372SRS, linear
based$7,644 $7,941 3.9%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology stereotactic radiosurgery volumes2
Who should invest?
Radiation oncology
Clinical considerations: Utilized in the treatment of primary and metastatic intracranial tumors,
arteriovenous malformations, and functional disorders; minimal fractionation (1-5 fractions) compared to
traditional radiation therapy
21.3K
21.4K
Due to the expensive and specialized nature of the platform, investing in a dedicated SRS machine is best
suited for organizations with a strong brain tumor program with high volumes looking to increase their
subspecialization. While the high cost of dedicated SRS machines is prohibitive for many organizations,
the option of delivering LINAC-based SRS by using lower-cost add-on components with an existing
LINAC removes some of the financial barriers to investment.
Source: Advisory Board Oncology Market Estimator; Service
Line Strategy Advisor research and analysis.
+0.5%
advisory.com60© 2020 Advisory Board • All rights reserved
Surface-Guided Radiation TherapyModerate cost and high potential patient throughput makes for a wise investment
Source: Guo, B. et al. "Surface Guided Radiation Therapy (SGRT): The Sensitivity Of The Region Of Interest (ROI) Selection On
The Translational And Rotational Accuracy For Whole Breast Irradiation". International Journal Of Radiation Oncology *Biology*
Physics, vol 99, no. 2, 2017; Herron, E. et al. "Surface Guided Radiation Therapy As A Replacement For Patient Marks In
Treatment Of Breast Cancer". International Journal Of Radiation Oncology *Biology* Physics, vol 102, no. 3, 2018; Kügele, Malin et
al. "Surface Guided Radiotherapy (SGRT) Improves Breast Cancer Patient Setup Accuracy". Journal Of Applied Clinical Medical
Physics, vol 20, no. 9, 2019; Advisory Board Oncology Market Estimator; Service Line Strategy Advisor research and analysis.
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Surface-guided radiation therapy (SGRT) is a tattoo-free radiation therapy that uses stereo vision technology to
monitor a patient’s external surface to ensure they are in the correct position before and during their radiation
treatment. SGRT checks the surface position during treatment and matches with data captured in the planning
or simulation process. Using SGRT, as opposed to marker-based techniques, allows for improved accuracy,
patient satisfaction, and throughput.
Adoption status: Early adopter
Major vendors: Vision RT, C-RAD
FDA status: Vision RT device approved in 2006
Key facts
Financial outlookMedicare HOPPS1 reimbursement
Who should invest?
Radiation oncology
Clinical considerations: Current use of SGRT for sites from head to toe, including, but not limited to,
brain, breast, and head & neck cancers. SGRT reduces need for immobilization and makes certain that
patients are in the required position for treatment in all six degrees of freedom.
The moderate cost of SGRT equipment, coupled with high potential patient throughput and thus low cost
per patient, makes the procedure a manageable investment for mid- to large-size programs. The added
benefits of SGRT compared to alternative methods means progressive centers have the opportunity to
differentiate themselves, but it is important to ensure patient volumes are high enough and there is
physician buy-in before investing.
HCPCS Description2019
Rate
2020
Rate
Percent
Change
77387
Guidance for
localization of target
volume for delivery
of radiation
treatment, includes
intrafraction tracking
n/a n/a n/a
Competing Products: Image-guided radiation therapy (IGRT), three-dimensional conformal radiation
therapy (3D CRT), intensity-modulated radiation therapy (IMRT)
2018 2023
National market estimatesOutpatient radiation therapy volumes3
13.0M
14.1M +8.6%
advisory.com61© 2020 Advisory Board • All rights reserved
2018 2023
Three-Dimensional Conformal Radiation TherapyUseof 3D CRT technology considered standard care offering
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Three-dimensional conformal radiation therapy (3D CRT) incorporates the use of highly-detailed imaging
technologies to plan the delivery of concentrated radiation dosage to a tumor. Using the three-dimensional
(3D) images of a patient’s tumor and surrounding organs, a more precise and effective radiation dose is
delivered directly to cancerous cells, while sparing nearby normal tissue. 3D images can be created using
either CT, MRI, PET, or PET-CT imaging technologies.
Adoption status: Late majority; used extensively but being replaced by IMRT for complicated body sites
FDA status: Approved in early 2000s
Major vendors: LINAC technologies: Accuray, Elekta, Varian; treatment planning software: Brainlab,
ViewRay
Competing products: Intensity-modulated radiation therapy (IMRT)
Key facts
HCPCS Description2019
rate
2020
rate
Percent
change
77295 3D radiotherapy plan $1,192 $1,245 4.4%
77470Special radiation
treatment$520 $539 3.7%
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology intensity-modulated radiation therapy
volumes2
Who should invest?
Radiation oncology
Clinical considerations: 3D CRT is used to treat tumors that may have previously been considered too
close to vital organs; it allows for high and more effective doses. It is most commonly used in treating brain,
head and neck, prostate, breast, liver, lung, and central nervous system tumors
1.4M
1.8M
Source: “NCI Dictionary of Cancer Terms.” National Cancer Institute,
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/3d-crt;
Advisory Board Oncology Market Estimator; Service Line Strategy
Advisor research and analysis.
3D CRT is a sound investment for AMCs and community hospitals alike, as it is considered a standard
care offering for any radiation therapy program. Although the system is costly, it has been proven more
cost-effective than conventional radiation therapy.
+26.1%
advisory.com62© 2020 Advisory Board • All rights reserved
2018 2023
Volumetric-Modulated Arc TherapyCenters with IMRT already in-place should invest in VMAT for better outcomes
1. Hospital Outpatient Prospective Payment System.
2. Volumes represent number of unique treatment visits by patients with a primary diagnosis of cancer.
This document does not constitute professional legal advice. Advisory Board does not endorse any companies, organizations or their products as identified or mentioned herein.
Advisory Board strongly recommends consulting legal counsel before implementing any practices contained in this document or making any decisions regarding suppliers and providers.
What is it?
Volumetric-modulated arc therapy (VMAT) utilizes LINAC control and treatment planning software to enable
the delivery of image-modulated radiation therapy in a continuous arc around the patient, as opposed to across
a number of finite gantry angles. Dose rate, multi-plane light conversion shape, and gantry speed are
modulated continuously throughout the treatment delivery arc. VMAT enables efficient delivery of a radiation
dose, and shortened treatment time may have clinical benefit.
Adoption status: Early majority; over 275 sites worldwide offer VMAT, with ~200 sites in the U.S.
FDA status: Approved in 2007
Major vendors: Varian (RapidArc); Elekta (Infinity, Versa HD), Philips Healthcare, Siemens
Competing products: Intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT)
Key facts
Financial outlookMedicare HOPPS1 reimbursement
National market estimatesOutpatient oncology IMRT volumes2
Who should invest?
Radiation oncology
Clinical considerations: VMAT offers more elegant dose distribution, reducing the time required for
radiation dose as compared to IMRT. The time-savings associated VMAT minimize stray patient or tumor
motion during treatment. However, clinical superiority of VMAT relative to IMRT is still under investigation.
Clinical use of VMAT for SBRT has also recently begun, suggesting greater adoption of the treatment in the
near future.
5.6M
7.1M
VMAT is a sound investment for AMCs and community hospitals that already have an IMRT system in place
since it is simply an add-on software and is expected to supplant IMRT as the preferred delivery method for
EBRT in the future. Institutions operating at or approaching capacity for radiation therapy should also
consider investing in VMAT to increase efficiency and patient throughput.
Source: Advisory Board Oncology Market Estimator;
Service Line Strategy research and analysis.
+26.1%
HCPCS Description 2019 rate 2020 ratePercent
change
77338 MLC device for IMRT $322 $335 4.0%
77385Ntsty modul rad tx dlvr
simple$520 $539 3.7%
77386Ntsty modul rad tx dlvr
complex$520 $539 3.7%
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