Medicare Benefits Schedule - Item 15565

Search Results for Item 15565

View Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

15565

15565 - Additional Information

Item Start Date:
01-Jan-2016
Description Start Date:
01-May-2018
Schedule Fee Start Date:
01-Jul-2019

Group
T2 - Radiation Oncology
Subgroup
5 - Computerised Planning

Preparation of an IMRT DOSIMETRY PLAN, which uses one or more CT image volume datasets, if:

(a)    in preparing the IMRT dosimetry plan:

    (i)    the differential between target dose and normal tissue dose is maximised, based on a review and assessment  by a radiation oncologist; and

    (ii)    all gross tumour targets, clinical targets, planning targets and organs at risk are rendered as volumes as defined in the prescription; and

    (iii)    organs at risk are nominated as planning dose goals or constraints and the prescription specifies the organs at risk as dose goals or constraints; and

    (iv)    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 in the plan; and

    (v)    a CT image volume dataset is used for the relevant region to be planned and treated; and

    (vi)    the CT images are suitable for the generation of quality digitally reconstructed radiographic images; and

(b) the final IMRT dosimetry plan is validated by the radiation therapist and the medical physicist, using robust quality assurance processes that include:

    (i)    determination of the accuracy of the dose fluence delivered by the multi-leaf collimator and gantryposition (static or dynamic); and

    (ii)    ensuring that the plan is deliverable, data transfer is acceptable and validation checks are completed on a linear accelerator; and

    (iii)    validating the accuracy of the derived IMRT dosimetry plan; and

(c)    the final IMRT dosimetry plan is approved by the radiation oncologist prior to delivery.

Fee: $3,366.85 Benefit: 75% = $2,525.15 85% = $3,283.45

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


Associated Notes

Category 3 - THERAPEUTIC PROCEDURES

TN.2.3

Planning Services - (Items 15500 to 15565 and 15850)

A planning episode involves field setting and dosimetry. One plan only will attract Medicare benefits in a course of treatment. However, benefits are payable for a plan for brachytherapy and a plan for megavoltage or teletherapy treatment, when rendered in the same course of treatment. 

  • further planning items where planning is undertaken in respect of a different tumour site to that (or those) specified in the original prescription by the radiation oncologist; and
  • a plan for brachytherapy and a plan for megavoltage or teletherapy treatment, when rendered in the same course of treatment. 

Items 15500 to 15533 (inclusive) are for a planning episode for 2D conformal radiotherapy. Items 15550 to 15562 (excluding item 15555) are for a planning episode for 3D conformal radiotherapy. Items 15555 and 15565 are for a planning episode for intensity modulated radiotherapy (IMRT). 

It is expected that the 2D simulation items (15500, 15503, and 15506) would be used in association with the 2D planning items (15518, 15521, and 15524) in a planning episode. However there may be instances where it may be appropriate to use the 3D Planning items (15556, 15559, and 15562) in association with the 2D simulation items (15500, 15503, and 15506) in a planning episode. The 3D simulation items (15550 and 15553) can only be billed in association with the 3D planning items (15556, 15559, and 15562) in a planning episode. However there may be instances where it may be appropriate to use the 3D Planning items (15556, 15559, and 15562) in association with the 2D simulation items (15500, 15503, and 15506) in a planning episode. The 3D simulation items (15550 and 15553) can only be billed in association with the 3D planning items (15556, 15559, and 15562) in a planning episode. The IMRT simulation item (15555) and IMRT dosimetry item (15565) can only be billed in association with each other and only for IMRT (i.e. neither IMRT simulation item 15555, nor IMRT dosimetry item 15565, can be billed in association with any of the 2D or 3D treatment items for an episode of care). 

Item 15850 covers radiation source localisation for high dose brachytherapy treatment. Item 15850 applies to brachytherapy provided to any part of the body.

 

Related Items: 15500 15503 15506 15509 15512 15513 15515 15518 15521 15524 15527 15530 15533 15536 15539 15550 15553 15555 15556 15559 15562 15565


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change