Medicare Benefits Schedule - Item 15974

Intermediate level dosimetry calculated on a volumetric dataset for intracavitary or intraluminal or endocavity applicators, for brachytherapy plans that have three‑dimensional image datasets acquired as part of simulation, if:

(a) the planning process is required to deliver the prescribed dose to a three‑dimensional volume, and relative to multiple line for channel delivery applicators (excluding interstitial catheters and needles and multi‑catheter devices); and

(b) based on review and assessment by a radiation oncologist, the planning process requires the differential of dose between target, organs at risk and normal tissue dose using avoidance strategies (which include placement of sources and/or dwell‑times or tissue packing); and

(c) delineation of structures is required as part of the planning process to produce a dose‑volume histogram integral to the avoidance strategies; and

(d) dose calculations are performed on a personalised basis, which must include three‑dimensional dose calculation to target and organ‑at‑risk volumes; and

(e) dose calculations and the dose‑volume histogram are approved and recorded with the plan

Applicable once per course of treatment

Fee: $927.75 Benefit: 75% = $695.85 85% = $829.05

(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