Medicare Benefits Schedule - Item 15976

Intermediate level dosimetry re‑planning of an initial brachytherapy plan described in item 15974 if treatment adjustments to that initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $463.90 Benefit: 75% = $347.95 85% = $394.35

(See para TN.2.5, TN.2.8 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

Only one additional dosimetry plan (for re-planning) is payable under items 15972, 15976 and 15980 during the treatment course (at 50% of the Schedule Fee for those items), when treatment adjustments are inadequate to satisfy treatment protocol requirements.

Re-planning may involve simulation (re-scanning the patient) and/or dosimetry (re-calculating dose) and verification. The clinical need for re-planning must be consistent with the guidance provided in this explanatory note and clearly documented in the patient’s record.

Related Items: 15972 15976 15980