Medicare Benefits Schedule - Note TN.2.11

MBS item 15990 is available for proton beam dosimetry and the preparation of a proton-photon comparative plan report, which applies to a service provided by a radiation oncologist for assessing an applicant’s eligibility for Proton Beam Therapy under the Medical Treatment Overseas Program (MTOP).

This item cannot be used to support proton-photon comparison planning for patients who will not be eligible for MTOP treatment. Cases that are considered palliative, experimental, or part of a clinical trial are not eligible for financial assistance under MTOP. Information about MTOP eligibility can be found at Medical Treatment Overseas Program | Australian Government Department of Health, Disability and Ageing.

The item is not intended to replace billing for photon services provided in Australia. If the patient does require photon treatment in Australia, eligible Megavoltage planning and treatment items may be billed for relevant services.

Planning validation

The final proton dosimetry plan should be:

(i) validated by a radiation therapist and a medical physicist, using quality assurance processes; and

(ii) approved by the radiation oncologist.

The photon component does not require a validated quality assurance processes for comparative planning.

Bulk billing

As outlined in the item descriptor, MBS item 15990 must be bulk-billed.

Related Items: 15990

• Previous - Note TN.2.10
• Next - Note TN.3.1

Proton beam dosimetry, and proton-photon comparative plan reporting, to assess eligibility for proton beam therapy via the Medical Treatment Overseas Program if:

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

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

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

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

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

(f) a three-dimensional or four-dimensional image volume dataset is used for the relevant region to be planned and verified; and

(g) the final proton dosimetry plan is:

(i) validated by a radiation therapist and a medical physicist, using quality assurance processes; and

(ii) approved by the radiation oncologist; and

(h) a proton-photon comparative plan report is generated; and

(i) the service is bulk-billed

Fee: $7,728.65 Benefit: 75% = $5,796.50 85% = $7,624.15

(See para TN.2.11 of explanatory notes to this Category)