Medicare Benefits Schedule - Note TR.3.1

Medicare benefits for items in Group T3 are only payable when the service is provided by a specialist or consultant physician with training in nuclear medicine.

Related Items: 16003 16006 16009 16012 16015 16018 16050 16055 16060

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Administration of Lutetium 177 PSMA, followed within 36 hours by whole body Lu-PSMA SPECT, for treatment of a patient with metastatic castrate resistant prostate cancer who is:

(a) PSMA-positive as determined by PSMA PET (defined as SUVmax >15 at a single site of disease and SUVmax >10 at all sites of measurable disease) after disease progression and

(b) prior treatment includes at least one taxane chemotherapy and at least one androgen receptor signalling inhibitor.

Applicable once per cycle, up to a maximum of 2 cycles in the initial treatment phase.

Fee: $8,000.00 Benefit: 75% = $6,000.00 85% = $7,895.50

(See para TR.3.1 of explanatory notes to this Category)

Administration of Lutetium 177 PSMA, followed within 36 hours by whole body Lu-PSMA SPECT, for treatment of a patient with metastatic castrate resistant prostate cancer, if:
(a) a service to which item 16050 applies has been provided; and
(b) the patient has not developed disease progression while receiving Lutetium 177 PSMA for this condition.

Applicable once per cycle, up to a maximum of 4 cycles in the continuing treatment phase.

Fee: $8,000.00 Benefit: 75% = $6,000.00 85% = $7,895.50

(See para TR.3.1 of explanatory notes to this Category)

¹⁷⁷Lutetium-DOTA-somatostatin receptor agonist treatment cycle for patients with histologically confirmed and inoperable neuroendocrine neoplasm (NEN), either locally advanced or metastatic, with documented disease progression or uncontrolled symptoms related to their NEN despite standard therapy who:
     a) have high tumour somatostatin receptor expression demonstrated on whole body 68Ga DOTA somatostatin agonist PET study; and
     b) are considered suitable for a course of 177Lutetium-DOTA-somatostatin receptor agonist therapy by a formally convened NEN      multidisciplinary board.

Includes the necessary patient preparation, administration and treatment, immediate patient aftercare required for the treatment cycle, consultation with the supervising specialist within 36 hours of treatment, and a post-infusion SPECT if performed.

Fee: $9,999.95 Benefit: 75% = $7,500.00 85% = $9,895.45

(See para TR.3.1 of explanatory notes to this Category)

Intra-cavitary administration of a therapeutic dose of Yttrium 90 (not including preliminary paracentesis and other than a service to which item 35404, 35406 or 35408 applies or a service associated with selective internal radiation therapy)

(Anaes.)

Fee: $1,655.45 Benefit: 75% = $1,241.60 85% = $1,550.95

(See para TN.3.1, TR.3.1 of explanatory notes to this Category)

Administration of a therapeutic dose of Iodine 131 for thyroid cancer by single dose technique

Fee: $1,115.95 Benefit: 75% = $837.00 85% = $1,011.45

(See para TR.3.1 of explanatory notes to this Category)

Administration of a therapeutic dose of Iodine 131 for thyrotoxicosis by single dose technique

Fee: $540.60 Benefit: 75% = $405.45 85% = $459.55

(See para TR.3.1 of explanatory notes to this Category)

Intravenous administration of a therapeutic dose of Phosphorous 32

Fee: $3,105.00 Benefit: 75% = $2,328.75 85% = $3,000.50

(See para TR.3.1 of explanatory notes to this Category)

Administration of Strontium 89 for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan), if systemic antineoplastic therapy is unavailable or has failed to control the patient’s disease and either:

a) the disease is poorly controlled by conventional radiotherapy; or

b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain.

Fee: $4,766.15 Benefit: 75% = $3,574.65 85% = $4,661.65

(See para TR.3.1 of explanatory notes to this Category)

Administration of ¹⁵³ Sm-lexidronam for the relief of bone pain due to skeletal metastases (as indicated by a positive bone scan), if systemic antineoplastic therapy is unavailable or has failed to control the patient’s disease, and:

a) the disease is poorly controlled by conventional radiotherapy; or

b) conventional radiotherapy is inappropriate, due to the wide distribution of sites of bone pain.

Fee: $5,128.30 Benefit: 75% = $3,846.25 85% = $5,023.80

(See para TR.3.1 of explanatory notes to this Category)