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: $152.50 Benefit: 75% = $114.40 85% = $129.65

(See para TN.2.5 of explanatory notes to this Category)

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Multiple services per attendance

For each attendance multiple services may be delivered, including:

1. insertion of the applicator;
2. simulation and dosimetry;
3. treatment;
4. verification; and
5. re-planning, if required.

Final dosimetry plans must be independently validated and documented by two qualified staff (radiation therapist or 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.

Multi-disciplinary team involvement in applicator insertion – Items 15958-15968

Multi-disciplinary team involvement may be required for items relating to applicator insertion (Items 15958-15968). This may include a:

1. Gynaecological oncologist; or
2. Urologist; or
3. Breast surgeon; or
4. Thoracic surgeon; or
5. Vascular surgeon; or
6. Gastro-intestinal surgeon; or
7. Plastic surgeon; or
8. General surgeon; or
9. Interventional radiologist; or
10. Ophthalmic surgeon.

Brachytherapy examples

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:

1. intracavitary vaginal vault with cylinder or ovoids or ring; or
2. intracavitary cervix 1, 2 or 3 channels; or
3. 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:

1. intracavitary intrauterine tubes and vaginal ovoids (T&O); or
2. intracavitary intrauterine tubes and vaginal ring (T&R); or
3. intracavitary intrauterine tubes and vaginal cylinder (T&Cyl); or
4. intracavitary vaginal cylinder; or
5. intracavitary vaginal mould; or
6. Intracavity vaginal ovoids; or
7. endocavity: single catheter balloon, single channel applicator; or
8. intraluminal brachytherapy; or
9. endovascular brachytherapy; or
10. surface (simple mould) brachytherapy.

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

1. hybrid intracavitary and interstitial applicators using:
   1. intrauterine tubes and vaginal ovoids (T&O) with needles; or
   2. intrauterine tube and vaginal ring (T&R) with needles; or
   3. intrauterine tubes and vaginal multichannel cylinder (T & VMC); or
2. vaginal multichannel cylinder (VMC); or
3. endocavity brachytherapy using a multi-catheter strut device or rectal multi-catheter device; or
4. interstitial brachytherapy, including anatomical sites such as vagina, prostate, breast, soft tissue; or
5. surface brachytherapy, including complex circumferential moulds or moulds with undulating or uneven contours.

Related Items: 15958 15960 15962 15964 15966 15968 15970 15972 15974 15976 15978 15980 15982 15984