Medicare Benefits Schedule - Note TN.3.3

177Lutetium-DOTA-somatostatin receptor agonist treatment is a type of peptide receptor radionuclide therapy which is given in multiple individual cycles over a period of time, with a period of recovery between cycles (typically 6-8 weeks). When a treatment cycle is repeated multiple times on a regular schedule, it is called a course of treatment.

An eligibility requirement for Item 16060 is that patients must be considered suitable for a course of 177Lutetium-DOTA-somatostatin receptor agonist therapy by a formally convened neuroendocrine neoplasm (NEN) multidisciplinary board.

For the purposes of Item 16060, a formally convened NEN multidisciplinary board is a formal board of relevant practitioners, including specialists in medical oncology and nuclear medicine with experience in managing NEN, endocrinology and surgery specialists, as well as medical practitioners from different areas of medical practice (including general practitioners). Allied health practitioners relevant to NEN treatment may be part of the board. The board must include at least one oncologist and one surgeon.

For Item 16060, the item refers to an individual treatment cycle and is inclusive of the following components of the service:

1. patient preparation required prior to the administration of the radiopharmaceutical in the treatment cycle (including the administration of the necessary prophylactic amino acid infusions and antiemetics),
2. the cost, preparation and administration of the radiopharmaceutical,
3. patient monitoring during the administration of the treatment (including the risk of carcinoid crisis and other severe hormonal flare syndromes) and immediate patient aftercare required for the safe discharge of the patient post-infusion,
4. a consultation with the supervising theranostic specialist within 36 hours of the time the treatment cycle occurred, to monitor patient progress and confirm individual medication and monitoring requirements with adjustments where necessary, and
5. post-infusion single photon emission tomography if performed.

Training requirements
Service providers administering this item should have the appropriate training and competency to deliver the service. Attendance of healthcare professionals skilled in the administration of therapeutic radiopharmaceuticals and associated patient care is required for this service. Remote supervision is not appropriate for this item.

The Australasian Association of Nuclear Medicine Specialists has published recommendations for therapeutic nuclear medicine training requirements in the AANMS Position Statement: Practice of Theranostics in Australia and provides theranostics training courses.

Additionally, the Royal Australian and New Zealand College of Radiologists has developed Competencies for Professional Development in Theranostics for radiologists.

 

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