Medicare Benefits Schedule - Note TN.2.8

Only one additional dosimetry plan (for re-planning) is payable under items 15972, 15976 and 15980 during the treatment course (at 50% of the Schedule Fee for those items), when treatment adjustments are inadequate to satisfy treatment protocol requirements.

Re-planning may involve simulation (re-scanning the patient) and/or dosimetry (re-calculating dose) and verification. The clinical need for re-planning must be consistent with the guidance provided in this explanatory note and clearly documented in the patient’s record.

Related Items: 15972 15976 15980

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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 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 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)