Radiation therapy cost: what to expect and how insurance covers it

Radiation therapy cost depends on the technique, number of fractions (sessions), and site of care. Medicare pays for radiation under the Outpatient Prospective Payment System (OPPS) at standardized rates. Commercial insurance varies. This guide walks through what drives the cost and what patients pay.

The short answer

Full course costs:

• External-beam radiation (IMRT / 3D-CRT), 15-35 sessions: total facility + physician charges typically billed in the $15,000–$50,000 range, with Medicare / insurance paying negotiated rates far below that.
• Stereotactic radiosurgery (SRS / SBRT), 1-5 sessions: higher per-session cost ($5,000–$15,000 per session) but fewer sessions, so total is often comparable.
• Brachytherapy (internal radiation): $10,000–$25,000 depending on procedure.
• Proton therapy: substantially more expensive than photon radiation; see the proton therapy cost guide.

What the patient pays is typically 20% Medicare Part B coinsurance (often covered by Medigap) or commercial-insurance coinsurance after deductible.

How radiation is billed

Unlike drugs, radiation is billed as a course of care with many individual CPT codes. Typical components:

• Simulation, including planning CT and setup (one-time)
• Treatment planning, including dosimetry and physician plan review (one-time; complex plans are billed at a higher rate)
• IMRT or 3D-CRT delivery (per session; CPT codes 77385 for IMRT, 77401 for basic, and 77402-77407 for 3D)
• Image guidance (IGRT) (per-session add-on where used)
• Physician management for weekly treatment visits (CPT 77427)

For Medicare, total reimbursement for a typical IMRT course (e.g., 30 fractions for prostate cancer) lands around $20,000-$30,000 including physician fees, varying by region.

Cost by cancer type

Breast cancer

• Whole-breast hypofractionated: 15-20 sessions. Typical Medicare total: $10,000–$18,000.
• Partial-breast irradiation: fewer sessions, lower cost.
• Post-mastectomy chest wall + nodes: longer course, higher cost.

Prostate cancer

• IMRT definitive: 25-45 sessions, highest total cost among common radiation indications (~$25,000–$50,000 Medicare).
• SBRT definitive (5 sessions): equivalent effectiveness for many patients, lower total cost despite higher per-session charges.
• Brachytherapy: single-procedure alternative, $15,000–$25,000.

Lung cancer

• SBRT for early-stage: 3-5 sessions, $15,000–$25,000.
• Chemoradiation for locally advanced: 30 sessions of IMRT + concurrent chemo.

Head and neck

• 30-35 sessions IMRT with concurrent chemotherapy. Among the most complex radiation plans.

Brain (SRS / Gamma Knife)

• 1-5 sessions for metastases or benign lesions. $15,000–$30,000 per treatment course.

Medicare coverage

Part B covers radiation therapy at:

• 20% coinsurance after the Part B deductible
• Medigap plans typically cover the 20%
• Medicare Advantage caps total annual out-of-pocket at $8,850 in-network (2024)

Physician services (simulation, treatment planning, weekly management) are billed under Part B separately from the facility’s OPPS charges.

There are no Medicare restrictions on most standard radiation modalities. Coverage for proton therapy is more limited (see proton therapy guide).

Commercial insurance

Most commercial plans cover standard radiation therapy. Coverage is rarely denied for conventional indications. Points to verify with your plan:

• In-network radiation oncologist and facility: out-of-network radiation can generate very large bills.
• Prior authorization: many plans require it, especially for IMRT and SBRT.
• Annual out-of-pocket maximum: your total exposure for the year is capped at this amount.
• Step therapy: some plans require trying conventional radiation before approving SBRT for specific indications.

Freestanding vs hospital-based

Radiation delivered at a hospital outpatient department is typically billed at higher rates than equivalent treatment at a freestanding radiation oncology center. Medicare pays more to hospitals for the same service. For commercial plans, site-of-service differential can be substantial.

If both options are available, the freestanding site often costs less. Ask your insurance for a cost estimate at each site before starting.

Uninsured / self-pay

Radiation is difficult to obtain as self-pay because few centers publish transparent cash-pay pricing. Options include:

• Hospital charity care: legally required at nonprofit hospitals. Apply through the financial counselor.
• Sliding-scale centers: some academic centers and community cancer programs offer income-based rates.
• Clinical trials: some trials include radiation therapy at no cost to participants.
• CancerCare financial assistance: can help with transportation and some copay costs.

See financial assistance for cancer patients.

What this guide doesn’t tell you

Radiation cost estimates vary significantly by geography, site of care, and technique. The figures above are ballpark ranges. What your center bills and what your insurance pays at its specific negotiated rate may differ from those ranges by tens of thousands of dollars.

Before starting a course, ask the cancer center’s financial counselor for:

1. A written cost estimate
2. Confirmation your radiation oncologist and facility are in-network
3. Your expected out-of-pocket

Next

• Proton therapy cost: different economics than photon radiation
• Chemotherapy cost: drug-side cost transparency
• Does Medicare cover cancer treatment?
• Financial assistance for cancer patients