Medicare Benefits Schedule - Note TN.2.10

This guidance provides details on billing information required by Services Australia to support the processing of Medicare claims for twice-daily treatments and claims for planning and treating multiple sites.

Claiming planning items for multiple sites (megavoltage items 15902-15910, 15914, 15920, 15924, 15926 and kilovoltage item 15950)

One plan only will attract Medicare benefits in a course of treatment.

Benefits are payable however for further planning items where planning is undertaken for another tumour site to that (or those) specified in the original prescription by the radiation oncologist.

To attract Medicare benefits, the claim for each planning item must uniquely identify the tumour site in the corresponding claiming/billing note for that claim (see below).

For intracranial stereotactic planning (item 15918), ‘intracranial’ is considered to be a single site (the cranium being defined as everything inside the bones of the skull).

Structures outside the cranium – including the bones of the skull, the scalp, and skin overlying the scalp - may have multiple sites requiring separate plans.

Claiming treatment items for multiple sites at one attendance (megavoltage items 15930-15940, 15944, 15946, 15948, and kilovoltage item 15954)

Where patients are being treated with radiation therapy to multiple sites of disease at one attendance, the claim for each treatment item must uniquely identify the tumour site in the corresponding claiming/billing note for that claim (see below).

Stereotactic treatment items (15942 and 15944)

• Intracranial stereotactic radiation therapy (15942) is applicable once per day.
• Stereotactic body radiation therapy (item 15944) is applicable once per day per site, for a maximum of 2 sites. When multiple plans are to be delivered to more than 2 sites in the same time frame, treatments to additional sites can be billed if delivered on different days.

Unique identification of sites in claiming/billing notes

Where multiple sites are involved, claims for both planning and treatment items must clearly identify a unique site of less than 30 characters (including spaces) in corresponding claiming/billing notes.

Please do not number each site or include terms such as ‘multiple sites’.

The full name of a body part must be specified. Abbreviations will not be accepted.

To differentiate site location in the same body part, terms may include: anterior, posterior, medial, lateral, proximal, distal, upper, middle, lower etc.

Examples of claims/billing notes required when submitting claims for planning and treatment items:

Claiming twice-daily treatments (items 15930-15940 and 15948)

The Medicare claims system is hard-wired to identify duplicate claims on the same day. When two legitimate claims are submitted for treatment to the same site on the same day, it is important to distinguish one claim from the other so that one of the claims is not treated as a duplicate.

Please observe the following claiming practices:

i.    Include the word “first” in claiming/billing notes for the first treatment of the day.

ii.   Include the word “second” in claiming/billing notes for the second treatment of the day.

Examples of claims/billing notes required when submitting claims for twice-daily, single-site treatment items:

Twice daily treatments to multiple sites on the same day

iii.  When treating multiple sites on the same day, the claim for each treatment item must clearly identify a unique site in the claim/billing note (see above).

iv.  Additionally, if one or more of the sites are being treated twice on the same day, identify the first and second treatments on the same day in claims/billing notes, as detailed in (i) and (ii).

Examples of claims/billing notes required when submitting claims for twice-daily treatments of multiple sites:

Related Items: 15902 15904 15906 15908 15910 15912 15914 15916 15918 15920 15922 15924 15926 15928 15930 15932 15934 15936 15938 15940 15942 15944 15946 15948

• Previous - Note TN.2.6
• Next - Note TN.2.11

Megavoltage planning—level 1.1

Simple complexity single‑field radiation therapy simulation and dosimetry for treatment planning, without imaging for field setting, if:

(a) all of the following apply in relation to the simulation:

(i) the simulation is to one site;

(ii) localisation is based on clinical mark‑up and image‑based simulation is not required;

(iii) patient set‑up and immobilisation techniques are suitable for two‑dimensional radiation therapy treatment, with wide margins and allowance for movement; and

(b) all of the following apply in relation to the dosimetry:

(i) the planning process is required to deliver a prescribed dose to a point, either at depth or on the surface of the patient;

(ii) based on review and assessment by a radiation oncologist, the planning process does not require the differential of dose between target, organs at risk and normal tissue dose;

(iii) delineation of structures is not possible or required, and field borders will delineate the treatment volume;

(iv) doses are calculated in reference to a point, either at depth or on the surface of the patient, from tables, charts or data from a treatment planning system

Applicable once per course of treatment

Fee: $762.15 Benefit: 75% = $571.65 85% = $657.65

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 1.2

Simple complexity radiation therapy simulation and dosimetry for treatment planning, with imaging for field setting, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for two‑dimensional radiation therapy dose planning;

(ii) patient set‑up and immobilisation techniques are suitable for two‑dimensional radiation therapy treatment where interfraction reproducibility is required;

(iii) imaging datasets are acquired for the relevant region of interest to be planned; and

(b) all of the following apply in relation to the dosimetry:

(i) the two‑dimensional planning process is required to calculate dose to a volume, however a dose‑volume histogram is not required to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the two‑dimensional planning process is not required to maximise the differential between target dose and normal tissue dose;

(iii) the target (which may include gross, clinical and planning targets as a composite structure or field border outline), as defined in the prescription, is rendered as a two‑dimensional structure as field borders or a volume;

(iv) organs at risk are delineated if required, and assessment of dose to these structures is derived from dose point calculations, rather than full calculation and inclusion in a dose‑volume histogram;

(v) dose calculations are calculated using a specialised algorithm, with prescription and plan details approved and recorded with the plan

Applicable once per course of treatment

Fee: $1,116.65 Benefit: 75% = $837.50 85% = $1,012.15

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 2.1

Three‑dimensional radiation therapy simulation and dosimetry for treatment planning, without motion management, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for three‑dimensional planning without consideration of motion management;

(ii) patient set‑up and immobilisation techniques are reproducible for treatment;

(iii) a high‑quality dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and

(b) all of the following apply in relation to the dosimetry:

(i) the three‑dimensional planning process is required to calculate dose to three‑dimensional volume structures and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the three‑dimensional planning process is required to optimise the differential between target dose and normal tissue dose;

(iii) the planning target volume is rendered as a three‑dimensional structure on planning outputs (three‑dimensional plan review, three‑planar sections review or dose‑volume histogram);

(iv) organs at risk are delineated, and assessment of dose to these structures is derived from calculation and inclusion in a dose‑volume histogram

Applicable once per course of treatment

Fee: $1,721.70 Benefit: 75% = $1,291.30 85% = $1,617.20

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 2.2

Three‑dimensional radiation therapy simulation and dosimetry for treatment planning with motion management, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for complex three‑dimensional planning with consideration of motion management;

(ii) patient set‑up and immobilisation techniques are reproducible for treatment;

(iii) a high‑quality three‑dimensional or four‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and

(b) all of the following apply in relation to the dosimetry:

(i) the three‑dimensional planning process is required to calculate dose to three‑dimensional volume structures (which must include structures moving with physiologic processes) and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the three‑dimensional planning process is required to optimise the differential between target dose and normal tissue dose;

(iii) the planning target volume is rendered as a three‑dimensional structure on planning outputs (three‑dimensional plan review, three‑planar sections review or dose‑volume histogram);

(iv) organs at risk are delineated, and assessment of dose to these structures is derived from full calculation and inclusion in a dose‑volume histogram

Applicable once per course of treatment

Fee: $2,783.40 Benefit: 75% = $2,087.55 85% = $2,678.90

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 3.1

Standard intensity modulated radiation therapy (IMRT) simulation and dosimetry for treatment planning, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for single‑dose level IMRT planning without motion management;

(ii) patient set‑up and immobilisation techniques are suitable for image volume data acquisition and reproducible IMRT treatment;

(iii) a high‑quality three‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and

(b) all of the following apply in relation to the dosimetry:

(i) the IMRT planning process is required to calculate dose to a single‑dose level volume structure and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the IMRT planning process optimises the differential between target dose, organs at risk and normal tissue dose;

(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered as volumes and nominated with planning dose objectives;

(iv) organs at risk are nominated as planning dose constraints;

(v) dose calculations and dose‑volume histograms are generated in an inverse planned process using a specialised algorithm, with prescription and plan details approved and recorded with the plan;

(vi) a three‑dimensional image volume dataset is used for the relevant region to be planned and treated with image verification

Applicable once per course of treatment

Fee: $4,352.40 Benefit: 75% = $3,264.30 85% = $4,247.90

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage re‑planning—level 3.1

Additional dosimetry plan for re‑planning of standard intensity modulated radiation therapy (IMRT) treatment, if:

(a) an initial treatment plan described in item 15910 or 15914 has been prepared; and

(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $2,176.20 Benefit: 75% = $1,632.15 85% = $2,071.70

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 3.2

Complex intensity modulated radiation therapy (IMRT) simulation and dosimetry for treatment planning, if

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for multiple‑dose level IMRT planning or single‑dose level IMRT planning requiring motion management;

(ii) patient set‑up and immobilisation techniques are suitable for image volume data acquisition and reproducible IMRT treatment;

(iii) a high‑quality three‑dimensional or four‑dimensional volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and

(b) all of the following apply in relation to the dosimetry:

(i) the IMRT planning process is required to calculate dose to multiple‑dose level volume structures or single‑dose level volume structures (including structures moving with physiologic processes or requiring precise positioning with respect to beam edges) and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the IMRT planning process optimises the differential between target dose, organs at risk and normal tissue dose;

(iii) all relevant gross tumour targets, clinical target volumes, planning target volumes, internal target volumes and organs at risk are rendered and nominated with planning dose objectives;

(iv) organs at risk are nominated as planning dose constraints;

(v) dose calculations and dose‑volume histograms are generated in an inverse planned process using a specialised algorithm, with prescription and plan details approved and recorded with the plan;

(vi) a three‑dimensional or four‑dimensional image volume dataset is used for the relevant region to be planned and treated, with image verification for a multiple‑dose level IMRT planning or single‑dose level IMRT planning requiring motion management

Applicable once per course of treatment

Fee: $6,255.35 Benefit: 75% = $4,691.55 85% = $6,150.85

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage re‑planning—level 3.2

Additional dosimetry plan for re‑planning of complex intensity modulated radiation therapy (IMRT) treatment, if:

(a) an initial treatment plan described in item 15910 or 15914 has been prepared; and

(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $3,127.65 Benefit: 75% = $2,345.75 85% = $3,023.15

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 4

Intracranial stereotactic radiation therapy (SRT) simulation and dosimetry for treatment planning, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for multiple non‑coplanar, rotational or fixed beam stereotactic delivery;

(ii) precise personalised patient set‑up and immobilisation techniques are suitable for reliable imaging acquisition and reproducible SRT small‑field and ablative treatments;

(iii) a high‑quality three‑dimensional image volume dataset is acquired in treatment position for the intracranial lesions to be planned and treated and verified; and

(b) all of the following apply in relation to the dosimetry:

(i) the planning process is required to calculate dose to single or multiple target structures and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the planning process maximises the differential between target dose, organs at risk and normal tissue dose;

(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered and nominated with planning dose objectives;

(iv) organs at risk are nominated as planning dose constraints;

(v) dose calculations and dose‑volume histograms are generated using a validated stereotactic‑type algorithm, with prescription and plan details approved and recorded with the plan

Applicable once per course of treatment

Fee: $7,013.95 Benefit: 75% = $5,260.50 85% = $6,909.45

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 4

Stereotactic body radiation therapy (SBRT) simulation and dosimetry for treatment planning, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for inverse planning with multiple non‑coplanar, rotational or fixed beam stereotactic delivery or intensity modulated radiation therapy (IMRT) stereotactic delivery;

(ii) personalised patient set‑up and immobilisation techniques are suitable for reliable imaging acquisition and reproducible, including techniques to minimise motion of organs at risk and targets;

(iii) small‑field and ablative treatment is used;

(iv) a high‑quality three‑dimensional or four‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned, treated and verified (through daily planar or volumetric image guidance strategies); and

(b) all of the following apply in relation to the dosimetry:

(i) the planning process is required to calculate dose to single or multiple target structures and requires a dose‑volume histogram to complete the planning process;

(ii) based on review and assessment by a radiation oncologist, the planning process maximises the differential between target dose, organs at risk and normal tissue dose;

(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered and nominated with planning dose objectives;

(iv) organs at risk are nominated as planning dose constraints;

(v) dose calculations and dose‑volume histograms are generated using a validated stereotactic‑type algorithm, with prescription and plan details approved and recorded with the plan

Applicable once per course of treatment

Fee: $7,013.95 Benefit: 75% = $5,260.50 85% = $6,909.45

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage re‑planning—level 4

Additional dosimetry plan for re‑planning of intracranial stereotactic radiation therapy (SRT) or stereotactic body radiation therapy (SBRT) treatment, if:

(a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15918 or 15920 has been prepared; and

(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $3,507.00 Benefit: 75% = $2,630.25 85% = $3,402.50

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 5

Specialised radiation therapy simulation and dosimetry for treatment planning, if both of the following apply in relation to the simulation:

(a) treatment set‑up and technique specifications are in preparation for a specialised case with general anaesthetic or sedation supervised by an anaesthetist;

(b) a high‑quality three‑dimensional or four‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification

Applicable once per course of treatment

(Anaes.)

Fee: $7,403.00 Benefit: 75% = $5,552.25 85% = $7,298.50

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage planning—level 5

Specialised radiation therapy simulation and dosimetry for treatment planning, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for a specialised application such as total skin electron therapy (TSE) or total body irradiation (TBI);

(ii) reproducible personalised patient set‑up and immobilisation techniques are suitable to implement three‑dimensional radiation therapy, intensity modulated radiation therapy (IMRT) (including multiple non‑coplanar, rotational or fixed beam treatment delivery) or a specialised total body treatment delivery method;

(iii) a specialised dataset of anatomical dimensions is acquired in the treatment position for TSE or TBI; and

(b) all of the following apply in relation to the dosimetry:

(i) total TSE, TBI, IMRT or multiple non‑coplanar, rotational or fixed beam treatment is used;

(ii) the final dosimetry plan is validated by a radiation therapist and a medical physicist, using quality assurance processes;

(iii) the final dosimetry plan is approved, prior to treatment delivery, by a radiation oncologist

Applicable once per course of treatment

Fee: $7,403.00 Benefit: 75% = $5,552.25 85% = $7,298.50

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage re‑planning—level 5

Additional dosimetry plan for re‑planning of specialised radiation therapy if:

(a) an initial treatment plan described in 15924 or 15926 has been prepared; and

(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

(Anaes.)

Fee: $3,701.50 Benefit: 75% = $2,776.15 85% = $3,597.00

(See para TN.2.1, TN.2.2, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 1.1

Radiation therapy for simple, single‑field treatment (including electron beam treatments), if:

(a) the treatment does not use imaging for field setting; and

(b) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(c) the treatment is delivered to implement a one‑dimensional plan; and

(d) a two‑dimensional single‑field treatment delivery mode is utilised

Applicable up to twice per plan per day

Fee: $95.90 Benefit: 75% = $71.95 85% = $81.55

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 1.2

Radiation therapy and image verification for simple treatment, with imaging for field setting, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a two‑dimensional plan, and

(c) two‑dimensional treatment is delivered; and

(d) image verification decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $119.45 Benefit: 75% = $89.60 85% = $101.55

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 2.1

Radiation therapy and image verification for three‑dimensional treatment, without motion management, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a standard three‑dimensional plan; and

(c) three‑dimensional treatment is delivered; and

(d) image verification decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $268.90 Benefit: 75% = $201.70 85% = $228.60

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 2.2

Radiation therapy and image verification for three‑dimensional treatment, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a complex three‑dimensional plan; and

(c) complex three‑dimensional treatment is delivered with management of motion; and

(d) image decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $292.50 Benefit: 75% = $219.40 85% = $248.65

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 3.1

Standard single‑dose level intensity modulated radiation therapy (IMRT) treatment and image verification, without motion management, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) imaging is used to implement an IMRT plan described in item 15910 or 15914

Applicable up to twice per plan per day

Fee: $292.50 Benefit: 75% = $219.40 85% = $248.65

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 3.2

Complex multiple‑dose level intensity modulated radiation therapy (IMRT) treatment, or single‑dose level IMRT treatment requiring motion management, and image verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) imaging is used (with motion management functionality if required) to implement an IMRT plan described in item 15910 or 15914; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $321.75 Benefit: 75% = $241.35 85% = $273.50

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 4

Intracranial stereotactic radiation therapy treatment and image verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) or minimally invasive stereotactic frame localisation is used to implement an intracranial stereotactic treatment plan at a level described in item 15918; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable once per day

Fee: $829.30 Benefit: 75% = $622.00 85% = $724.80

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 4

Stereotactic body radiation therapy (SBRT) treatment and image verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) image‑guided radiation therapy (IGRT) is used (with motion management functionality if required) to implement a stereotactic body radiation therapy plan at a level described in item 15920; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable once per day per site, for a maximum of 2 sites

Fee: $829.30 Benefit: 75% = $622.00 85% = $724.80

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 5

Specialised radiation therapy treatment and verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) a specialised technique is used to implement a treatment plan with general anaesthetic or sedation supervised by an anaesthetist

Applicable once per plan per day

Fee: $953.70 Benefit: 75% = $715.30 85% = $849.20

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)

Megavoltage treatment—level 5
Specialised radiation therapy treatment and verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) a specialised technique, such as total skin electron therapy (TSE) or total body irradiation (TBI), is used to implement a treatment plan described in item 15926

Applicable up to twice per day

Fee: $953.70 Benefit: 75% = $715.30 85% = $849.20

(See para TN.2.1, TN.2.3, TN.2.10 of explanatory notes to this Category)