Medicare Benefits Schedule - Note TN.2.9

15962 – an example of an endocavity applicator could be a single channel rectal tube

15964 - an example of a hybrid intracavitary and interstitial or multi-catheter applicators, could be a multi-channel cylinder for vaginal or rectal treatment.

15968 - radioactive sources for permanent implants, for example lung.

15970 – Examples of simple level dosimetry plans prescribed to surface or depth from catheter and library plans, could include:

(a) intracavitary vaginal vault with cylinder or ovoids or ring; or

(b) intracavitary cervix 1, 2 or 3 channels; or

(c) intraluminal single lines, for example, for treatment of carcinoma of the bronchus.

15974 - Intermediate level dosimetry is for plans that have three-dimensional image datasets acquired as part of simulation, and could include any of the following:

(a) intracavitary intrauterine tubes and vaginal ovoids (T&O); or

(b) intracavitary intrauterine tubes and vaginal ring (T&R); or

(c) intracavitary intrauterine tubes and vaginal cylinder (T&Cyl); or

(d) intracavitary vaginal cylinder; or

(e) intracavitary vaginal mould; or

(f) Intracavity vaginal ovoids; or

(g) endocavity: single catheter balloon, single channel applicator; or

(h) intraluminal brachytherapy; or

(i) endovascular brachytherapy; or

(j) surface (simple mould) brachytherapy.

15978 - Complex level dosimetry is for plans that contain multiple needles or catheters or radiation sources, for example:

(a) hybrid intracavitary and interstitial applicators using:

i. intrauterine tubes and vaginal ovoids (T&O) with needles; or

ii. intrauterine tube and vaginal ring (T&R) with needles; or

iii. intrauterine tubes and vaginal multichannel cylinder (T & VMC); or

(b) vaginal multichannel cylinder (VMC); or

(c) endocavity brachytherapy using a multi-catheter strut device or rectal multi-catheter device; or

(d) interstitial brachytherapy, including anatomical sites such as vagina, prostate, breast, soft tissue; or

surface brachytherapy, including complex circumferential moulds or moulds with undulating or uneven contours.

Related Items: 15924 15926 15928 15946 15948

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Megavoltage planning—level 5

Specialised radiation therapy simulation and dosimetry for treatment planning, if both of the following apply in relation to the simulation:

(a) treatment set‑up and technique specifications are in preparation for a specialised case with general anaesthetic or sedation supervised by an anaesthetist;

(b) a high‑quality three‑dimensional or four‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification

Applicable once per course of treatment

(Anaes.)

Fee: $7,046.30 Benefit: 75% = $5,284.75 85% = $6,947.60

(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)

Megavoltage planning—level 5

Specialised radiation therapy simulation and dosimetry for treatment planning, if:

(a) all of the following apply in relation to the simulation:

(i) treatment set‑up and technique specifications are in preparation for a specialised application such as total skin electron therapy (TSE) or total body irradiation (TBI);

(ii) reproducible personalised patient set‑up and immobilisation techniques are suitable to implement three‑dimensional radiation therapy, intensity modulated radiation therapy (IMRT) (including multiple non‑coplanar, rotational or fixed beam treatment delivery) or a specialised total body treatment delivery method;

(iii) a specialised dataset of anatomical dimensions is acquired in the treatment position for TSE or TBI; and

(b) all of the following apply in relation to the dosimetry:

(i) total TSE, TBI, IMRT or multiple non‑coplanar, rotational or fixed beam treatment is used;

(ii) the final dosimetry plan is validated by a radiation therapist and a medical physicist, using quality assurance processes;

(iii) the final dosimetry plan is approved, prior to treatment delivery, by a radiation oncologist

Applicable once per course of treatment

Fee: $7,046.30 Benefit: 75% = $5,284.75 85% = $6,947.60

(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)

Megavoltage re‑planning—level 5

Additional dosimetry plan for re‑planning of specialised radiation therapy if:

(a) an initial treatment plan described in 15924 or 15926 has been prepared; and

(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements

Applicable once per course of treatment

(Anaes.)

Fee: $3,523.15 Benefit: 75% = $2,642.40 85% = $3,424.45

(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)

Megavoltage treatment—level 5

Specialised radiation therapy treatment and verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) a specialised technique is used with general anaesthetic or sedation supervised by an anaesthetist

Applicable once per plan per day

Fee: $907.75 Benefit: 75% = $680.85 85% = $809.05

(See para TN.2.1, TN.2.3, TN.2.9 of explanatory notes to this Category)

Megavoltage treatment—level 5

Specialised radiation therapy treatment and verification, if:

(a) the treatment is delivered using a device that is included in the Australian Register of Therapeutic Goods; and

(b) a specialised technique, such as total skin electron therapy (TSE) or total body irradiation (TBI), is used to implement a treatment plan described in item 15926; and

(c) image‑guided radiation therapy (IGRT) is used (with motion management functionality, if required) to implement:

(i) three‑dimensional radiation therapy; or

(ii) intensity modulated radiation therapy (IMRT) (including multiple non‑coplanar, rotational or fixed beam treatment); or

(iii) total skin electrons (TSE) where there is individualised treatment

Applicable once per day

Fee: $907.75 Benefit: 75% = $680.85 85% = $809.05

(See para TN.2.1, TN.2.3, TN.2.9 of explanatory notes to this Category)