Medicare Benefits Schedule - Note TN.2.5

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

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Simple placement or insertion of any of the following kinds of brachytherapy device, without image guidance:

(a) intracavitary vaginal cylinder, vaginal ovoids, vaginal ring or vaginal mould;

(b) surface mould or applicator, with catheters fixed to or embedded into mould or applicator, on external surface of body;

including the removal of applicators, catheters or needles

Fee: $106.40 Benefit: 75% = $79.80 85% = $90.45

(See para TN.2.5, TN.2.7 of explanatory notes to this Category)

Complex construction and manufacture of a personalised brachytherapy applicator or mould, derived from three dimensional image volume datasets, to treat intracavitary, intraoral or intranasal site, including the removal of applicators, catheters or needles

Fee: $146.80 Benefit: 75% = $110.10 85% = $124.80

(See para TN.2.5, TN.2.7 of explanatory notes to this Category)

Complex insertion of any of the following kinds of brachytherapy device, with image guidance and if a radiation oncologist is in attendance at the initiation of the service:

(a) intrauterine tubes with or without ovoids, ring or cylinder;

(b) endocavity applicators;

(c) intraluminal catheters for treatment of bronchus, trachea, oesophagus, nasopharynx, bile duct;

(d) endovascular catheters for treatment of vessels;

including the removal of applicators, catheters or needles

(Anaes.)

Fee: $319.15 Benefit: 75% = $239.40 85% = $271.30

(See para TN.2.5, TN.2.7 of explanatory notes to this Category)

Complex insertion and removal of hybrid intracavitary and interstitial brachytherapy applicators, or intracavitary and multi catheter applicators, with image guidance and if a radiation oncologist is in attendance at the initiation of the service

(Anaes.)

Fee: $425.60 Benefit: 75% = $319.20 85% = $361.80

(See para TN.2.5, TN.2.7 of explanatory notes to this Category)

Complex insertion of any of the following kinds of interstitial brachytherapy implants not requiring surgical exposure, with image guidance, and if a radiation oncologist is in attendance during the service:

(a) catheters or needles for temporary implants;

(b) radioactive sources for permanent implants;

(c) breast applicators, single channel and multi‑channel strut devices;

including the removal of applicators, catheters or needles

(Anaes.)

Fee: $531.95 Benefit: 75% = $399.00 85% = $452.20

(See para TN.2.5, TN.2.6, TN.2.7 of explanatory notes to this Category)

Complex insertion of any of the following interstitial brachytherapy implants requiring surgical exposure (other than a service to which item 15900 applies), if a radiation oncologist is in attendance at the initiation of the service:

(a) catheters, needles or applicators to a region requiring surgical exposure;

(b) radioactive sources for permanent implants;

(c) surface moulds during intraoperative brachytherapy;

(d) plastic catheters or stainless steel needles, requiring surgical exposure;

including implantation and removal of applicators, catheters or needles

(Anaes.)

Fee: $833.80 Benefit: 75% = $625.35 85% = $735.10

(See para TN.2.5, TN.2.7 of explanatory notes to this Category)

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)

Simple level dosimetry re‑planning of an initial brachytherapy plan described in item 15970 if treatment adjustments to that initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $69.20 Benefit: 75% = $51.90 85% = $58.85

(See para TN.2.5, TN.2.8 of explanatory notes to this Category)

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)

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)

Complex level dosimetry for brachytherapy plans that contain multiple needles, catheters or radiation sources, calculated on the three‑dimensional volumetric dataset, if:

(a) the planning process is required to deliver a prescribed dose to a target volume relative to multiple channel delivery applicators, needles or catheters or radiation sources; and

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

(c) delineation of structures is required as part of the planning process, in order to produce a dose‑volume histogram to review and assess the plan; 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: $1,078.10 Benefit: 75% = $808.60 85% = $979.40

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

Complex level dosimetry re‑planning of an initial brachytherapy plan described in item 15978 if treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

Fee: $539.10 Benefit: 75% = $404.35 85% = $458.25

(See para TN.2.5, TN.2.8 of explanatory notes to this Category)

Brachytherapy treatment, if:

(a) the service is performed by radiation therapists and medical physicists; and

(b) a radiation oncologist is in attendance during the service; and

(c) the treatment is to implement a brachytherapy treatment plan described in any of items 15970, 15972, 15974, 15976, 15978 and 15980

Fee: $404.25 Benefit: 75% = $303.20 85% = $343.65

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

Verification of position of brachytherapy applicators, needles, catheters or radioactive sources, if:

(a) a two‑dimensional or three‑dimensional volumetric image set, or a validated in‑vivo dosimetry measurement, is required to facilitate an adjustment to the applicators, needles, catheters or dosimetry plan; and

(b) decisions using the acquired images are based on action algorithms and enacted immediately prior to, or during, treatment, where treatment is preceded by manipulation or adjustment of delivery applicator or adjustment of the dosimetry plan; and

(c) the service is associated with a service to which any of the following items apply:

(i) items 15958 to 15968;

(ii) item 15982

Fee: $148.95 Benefit: 75% = $111.75 85% = $126.65

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