Medicare Benefits Schedule - Item 15984

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)

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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