Medicare Benefits Schedule - Item 15970

Simple level dosimetry for brachytherapy plans prescribed to surface or depth from catheter and library plans, if:

(a) the planning process is required to deliver a prescribed dose to a three‑dimensional volume, and relative to a single line or multiple channel delivery applicator; and

(b) the planning process does not require the differential of dose between the target, organs at risk and normal tissue dose; and

(c) delineation of structures is not required; and

(d) dose calculations are performed in reference to the surface or a point at depth (two‑dimensional plan) from tables, charts or data from a treatment planning system library plan

Applicable once per course of treatment

Fee: $138.35 Benefit: 75% = $103.80 85% = $117.60

(See para TN.2.5 of explanatory notes to this Category)

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For each course of treatment there may be multiple applicator insertions. Each insertion is considered a new attendance (or episode of care). For each attendance there may be a claim for the relevant descriptors for items 15958-15984, including:

(a)     insertion of the applicator;

(b)     simulation and dosimetry;

(c)     treatment;

(d)     verification; and

(e)     re-planning, if required.

Final dosimetry plans must be validated by both the radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to the delivery, which must include ensuring data transfer is acceptable and validation checks are completed.

Related Items: 15958 15960 15962 15964 15966 15968 15970 15972 15974 15976 15978 15980 15982 15984