Medicare Boosts Access to Revolutionary Biology-Guided Cancer Therapy

HAYWARD, CA – April 01, 2026 – In a landmark decision poised to reshape cancer care access across the United States, RefleXion Medical has secured expanded Medicare payment for its innovative SCINTIX autonomous radiotherapy. Noridian Healthcare Solutions, a major Medicare Administrator Contractor (MAC), has established favorable, accretive payment rates for the therapy in freestanding cancer centers, significantly broadening its availability to patients.

The move by Noridian, which covers 16 states and several U.S. territories including California, Arizona, and Washington, follows similar decisions from two other MACs covering southern and eastern states. This trifecta of approvals effectively removes a critical financial barrier for community-based clinics, potentially granting hundreds of thousands of Medicare patients access to a cutting-edge treatment that uses a tumor's own biology to guide radiation.

“We are buoyed by this latest reimbursement payment decision because it removes an important barrier to patient access,” said Todd Powell, president and CEO at RefleXion. “It also provides reassurance and support to freestanding center providers in over half of U.S. states and territories who strive to incorporate innovative treatments like SCINTIX therapy for their patients within their communities.”

A New Lifeline for Freestanding Cancer Centers

This reimbursement expansion is particularly significant for the nation's freestanding cancer centers. These community-based clinics are a cornerstone of oncology care, providing over 40% of all radiation therapy treatments in the U.S. and offering a vital alternative to large hospital systems, especially for patients in suburban and rural areas.

However, these independent centers have been operating under increasing financial pressure. For years, they have faced a challenging reimbursement environment, often receiving lower Medicare payments than their hospital-based counterparts for identical services. This disparity, coupled with consistent cuts to conventional radiation oncology services, has made it exceedingly difficult for them to invest in and adopt expensive, next-generation technologies.

The decision by Medicare administrators to establish accretive payment for SCINTIX—meaning rates that are higher than for conventional radiotherapy—directly addresses this challenge. It provides the financial foundation necessary for these centers to acquire the RefleXion X2 platform and offer this advanced therapy, leveling the playing field and ensuring that access to innovation is not limited by a patient's proximity to a major academic medical center.

Decoding the 'Accretive Payment' Advantage

The term "accretive payment" is not merely industry jargon; it represents a tangible financial validation of SCINTIX's technological leap. While conventional radiation therapy payments have faced downward pressure, Medicare has recognized the unique value and resource intensity of RefleXion's system with a distinct and more generous reimbursement structure.

Effective January 1, 2025, CMS established two new G-codes for the therapy. The first, G0562, covers the unique pre-treatment "functional modeling" procedure, which has both a technical component and a professional component acknowledging the additional physician work required. The second, G0563, covers the delivery of each treatment session.

The financial difference is stark. MACs have set the technical payment for a single SCINTIX delivery session (G0563) at approximately $3,750. In contrast, the 2025 national average payment rate in a hospital outpatient setting for a conventional Stereotactic Body Radiotherapy (SBRT) session is $1,755. This reimbursement, nearly double that of a comparable advanced therapy, acknowledges that SCINTIX is not just an incremental improvement but a fundamentally different approach to treatment delivery.

Redefining Treatment with Biology-Guided Radiotherapy

The premium reimbursement rate is a direct reflection of the novel technology at the heart of the SCINTIX system. It is the first and only commercially available platform to perform biology-guided radiotherapy, a concept that turns a patient's cancer into a real-time guidance system.

The process begins with a single injection of a common radiotracer, fluorodeoxyglucose (FDG), which is absorbed by metabolically active cancer cells. The SCINTIX machine then detects the faint emissions from the radiotracer, effectively turning each tumor into a biological beacon that signals its precise location and movement in real-time. The system uses this live biological data to continuously aim and deliver the radiation beam, ensuring maximum dose to the cancer while minimizing exposure to surrounding healthy tissue.

This approach, which earned the technology a Breakthrough Device designation from the FDA for treating lung tumors, is a significant departure from conventional methods that rely on static images taken before treatment. By tracking the tumor itself, SCINTIX can account for motion caused by breathing and other bodily functions, a persistent challenge in radiation oncology. The technology is currently FDA-cleared for treating lung and bone tumors, including those that have spread from other cancers, with the potential to one day treat multiple metastatic sites in a single session.

A Strategic Success in a Shifting Landscape

RefleXion's success in securing this payment pathway is even more remarkable when viewed against the backdrop of the broader reimbursement landscape. Professional organizations like the American Society for Radiation Oncology (ASTRO) have reported a cumulative 23% decline in Medicare payments for radiation oncology since 2011, creating a difficult environment for providers.

By navigating the specific pathways designed for innovation, RefleXion has charted a different course. After receiving its Breakthrough Device designation, the company leveraged the New Technology Ambulatory Payment Classification (NT-APC) pathway, which is designed to facilitate the adoption of novel procedures in hospital outpatient settings. The subsequent transition to G-codes and the establishment of accretive, geographically adjusted rates by individual MACs like Noridian represent the final, crucial steps in solidifying financial support for SCINTIX in both hospital and freestanding settings.

This journey provides a potential blueprint for other medical technology firms developing transformative therapies. It demonstrates that despite general fiscal pressures, a clear case for clinical innovation and value can lead to dedicated and favorable reimbursement. The expanded coverage now positions RefleXion for accelerated market adoption, with the company estimating that the Medicare updates will allow approximately 400,000 additional patients, including those with metastatic disease, to access SCINTIX therapy. For these patients and the community clinics that serve them, this decision marks a pivotal step toward a more accessible and advanced future in the fight against cancer.