Medicare Benefits Schedule - Note TN.2.3

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 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. Benefits are also payable for more than one plan when a plan for brachytherapy and a plan for megavoltage or teletherapy treatment are 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.

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

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RADIOTHERAPY PLANNING

RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15509 applies)

Fee: $267.15 Benefit: 75% = $200.40 85% = $227.10

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

RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15512 applies)

Fee: $342.95 Benefit: 75% = $257.25 85% = $291.55

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

RADIATION FIELD SETTING using a simulator or isocentric xray or megavoltage machine or CT of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (not being a service associated with a service to which item 15515 applies)

Fee: $512.15 Benefit: 75% = $384.15 85% = $435.35

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

RADIATION FIELD SETTING using a diagnostic xray unit of a single area for treatment by a single field or parallel opposed fields (not being a service associated with a service to which item 15500 applies)

Fee: $231.45 Benefit: 75% = $173.60 85% = $196.75

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

RADIATION FIELD SETTING using a diagnostic xray unit of a single area, where views in more than 1 plane are required for treatment by multiple fields, or of 2 areas (not being a service associated with a service to which item 15503 applies)

Fee: $298.40 Benefit: 75% = $223.80 85% = $253.65

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

RADIATION SOURCE LOCALISATION using a simulator or x-ray machine or CT of a single area, where views in more than 1 plane are required, for brachytherapy treatment planning for I125 seed implantation of localised prostate cancer, in association with item 15338

Fee: $337.40 Benefit: 75% = $253.05 85% = $286.80

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

RADIATION FIELD SETTING using a diagnostic xray unit of 3 or more areas, or of total body or half body irradiation, or of mantle therapy or inverted Y fields, or of irregularly shaped fields using multiple blocks, or of offaxis fields or several joined fields (not being a service associated with a service to which item 15506 applies)

Fee: $432.10 Benefit: 75% = $324.10 85% = $367.30

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

RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks

Fee: $84.75 Benefit: 75% = $63.60 85% = $72.05

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

RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used

Fee: $374.15 Benefit: 75% = $280.65 85% = $318.05

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

RADIATION DOSIMETRY by a CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields

Fee: $701.50 Benefit: 75% = $526.15 85% = $602.80

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

RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy by a single field or parallel opposed fields to 1 area with up to 2 shielding blocks

Fee: $86.90 Benefit: 75% = $65.20 85% = $73.90

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

RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy to a single area by 3 or more fields, or by a single field or parallel opposed fields to 2 areas, or where wedges are used

Fee: $387.60 Benefit: 75% = $290.70 85% = $329.50

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

RADIATION DOSIMETRY by a non CT interfacing planning computer for megavoltage or teletherapy radiotherapy to 3 or more areas, or by mantle fields or inverted Y fields, or tangential fields or irregularly shaped fields using multiple blocks, or offaxis fields, or several joined fields

Fee: $734.95 Benefit: 75% = $551.25 85% = $636.25

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

BRACHYTHERAPY PLANNING, computerised radiation dosimetry

Fee: $293.75 Benefit: 75% = $220.35 85% = $249.70

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

BRACHYTHERAPY PLANNING, computerised radiation dosimetry for I125 seed implantation of localised prostate cancer, in association with item 15338

Fee: $690.45 Benefit: 75% = $517.85 85% = $591.75

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

SIMULATION FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY without intravenous contrast medium, where:

(a)    treatment set up and technique specifications are in preparations for three dimensional conformal radiotherapy dose planning; and

(b)    patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and three dimensional conformal radiotherapy treatment; and

(c)    a high-quality CT-image volume dataset must be acquired for the relevant region of interest to be planned and treated; and

(d)    the image set must be suitable for the generation of quality digitally reconstructed radiographic images

Fee: $724.90 Benefit: 75% = $543.70 85% = $626.20

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

SIMULATION FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY pre and post intravenous contrast medium, where:

(a)    treatment set up and technique specifications are in preparations for three dimensional conformal radiotherapy dose planning; and

(b)    patient set up and immobilisation techniques are suitable for reliable CT image volume data acquisition and three dimensional conformal radiotherapy treatment; and

(c)    a high-quality CT-image volume dataset must be acquired for the relevant region of interest to be planned and treated; and

(d)    the image set must be suitable for the generation of quality digitally reconstructed radiographic images

Fee: $782.15 Benefit: 75% = $586.65 85% = $683.45

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

SIMULATION FOR INTENSITY-MODULATED RADIATION THERAPY (IMRT), with or without intravenous contrast medium, if:

1.    treatment set-up and technique specifications are in preparations for three-dimensional conformal radiotherapy dose planning; and

2.    patient set-up and immobilisation techniques are suitable for reliable CT-image volume data acquisition and three-dimensional conformal radiotherapy; and

3.    a high-quality CT-image volume dataset is acquired for the relevant region of interest to be planned and treated; and

4.    the image set is suitable for the generation of quality digitally-reconstructed radiographic images.

Fee: $782.15 Benefit: 75% = $586.65 85% = $683.45

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

DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 1 COMPLEXITY where:

(a)    dosimetry for a single phase three dimensional conformal treatment plan using CT image volume dataset and having a single treatment target volume and organ at risk; and

(b)    one gross tumour volume or clinical target volume, plus one planning target volume plus at least one relevant organ at risk as defined in the prescription must be rendered as volumes; and

(c)    the organ at risk must be nominated as a planning dose goal or constraint and the prescription must specify the organ at risk dose goal or constraint; and

(d)    dose volume histograms must be generated, approved and recorded with the plan; and

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

(f)    the CT images must be suitable for the generation of quality digitally reconstructed radiographic images

Fee: $731.35 Benefit: 75% = $548.55 85% = $632.65

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

DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 2 COMPLEXITY where:

(a)    dosimetry for a two phase three dimensional conformal treatment plan using CT image volume dataset(s) with at least one gross tumour volume, two planning target volumes and one organ at risk defined in the prescription; or

(b)    dosimetry for a one phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, one planning target volume and two organ at risk dose goals or constraints defined in the prescription; or

(c)    image fusion with a secondary image (CT, MRI or PET) volume dataset used to define target and organ at risk volumes in conjunction with and as specified in dosimetry for three dimensional conformal radiotherapy of level 1 complexity.

All gross tumour targets, clinical targets, planning targets and organs at risk as defined in the prescription must be rendered as volumes. The organ at risk must be nominated as planning dose goals or constraints and the prescription must specify the organs at risk as dose goals or constraints. Dose volume histograms must be generated, approved and recorded with the plan. A CT image volume dataset must be used for the relevant region to be planned and treated. The CT images must be suitable for the generation of quality digitally reconstructed radiographic images

Fee: $953.85 Benefit: 75% = $715.40 85% = $855.15

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

DOSIMETRY FOR THREE DIMENSIONAL CONFORMAL RADIOTHERAPY OF LEVEL 3 COMPLEXITY - where:

(a)    dosimetry for a three or more phase three dimensional conformal treatment plan using CT image volume dataset(s) with at least one gross tumour volume, three planning target volumes and one organ at risk defined in the prescription; or

(b)    dosimetry for a two phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, and

        (i) two planning target volumes; or

        (ii) two organ at risk dose goals or constraints defined in the prescription.

or

(c)    dosimetry for a one phase three dimensional conformal treatment plan using CT image volume datasets with at least one gross tumour volume, one planning target volume and three organ at risk dose goals or constraints defined in the prescription;

or

(d)    image fusion with a secondary image (CT, MRI or PET) volume dataset used to define target and organ at risk volumes in conjunction with and as specified in dosimetry for three dimensional conformal radiotherapy of level 2 complexity.

All gross tumour targets, clinical targets, planning targets and organs at risk as defined in the prescription must be rendered as volumes. The organ at risk must be nominated as planning dose goals or constraints and the prescription must specify the organs at risk as dose goals or constraints. Dose volume histograms must be generated, approved and recorded with the plan. A CT image volume dataset must be used for the relevant region to be planned and treated. The CT images must be suitable for the generation of quality digitally reconstructed radiographic images

Fee: $1,233.65 Benefit: 75% = $925.25 85% = $1,134.95

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

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: $3,647.50 Benefit: 75% = $2,735.65 85% = $3,548.80

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