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Category 3 - THERAPEUTIC PROCEDURES
TN.2.2
Megavoltage planning
Radiation therapy planning (15902 – 15928, 15950, 15970 – 15980)
One plan only will attract Medicare benefits in a course of treatment. Benefits are payable however for further planning items where planning is undertaken for a synchronous primary or different tumour site to that (or those) specified in the original prescription by the radiation oncologist. Sites must be clearly identified and differentiated by name in billing notes (e.g., Breast, Pelvis, Brain).
Protocols for documenting quality assurance processes for treatment plans (15902 to 15928 and 15970 to 15980, 15964 and 15968)
Treatment plans should be produced using quality assurance processes to ensure, where appropriate:
(a) Data within the oncology information system is accurate; and
(b) Data transfer to the Oncology Information System has been completed without any loss of data integrity; and
(c) The plan is deliverable without loss of dosimetric accuracy on the radiation therapy apparatus which will be used for clinical delivery (including particular consideration given to geometric accuracy where tight margins or steep dose gradient are employed); and
(d) Motion management strategies and accuracy of delivery have been appropriately assessed; and
(e) The dose calculation of the treatment plan (including on the patient planning images) is accurate; and
(f) The accuracy of any image fusions performed; and
(g) The final treatment plan is validated by a radiation therapist or medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to delivery .
The quality assurance processes should be established, maintained and performed by radiation therapists and medical physicists and should be formally documented.
Protocols for documenting quality assurance processes for treatment re-plans (15912, 15916, 15922 and 15928)
Treatment re-plans can only be performed if:
(a) An initial treatment plan has been prepared in accordance with the item descriptor; and
(b) Treatment adjustments to the original plan are inadequate to satisfy treatment protocol requirements.
Treatment re-plans should be produced using quality assurance processes to ensure, where appropriate:
(a) Data within the oncology information system is accurate; and
(b) Data transfer to the Oncology Information System has been completed without any loss of data integrity; and
(c) The re-plan is deliverable without loss of dosimetric accuracy on the radiation therapy apparatus which will be used for clinical delivery (including particular consideration given to geometric accuracy where tight margins or steep dose gradient are employed); and
(d) Motion management strategies and accuracy of delivery have been appropriately assessed; and
(e) The dose calculation of the treatment re-plan (including on the patient planning images) is accurate; and
(f) The accuracy of any image fusions performed.
(g) The additional dosimetry re-plan should be established, maintained, validated and performed by both a radiation therapist and medical physicist, using quality assurance processes, with the re-plan approved by the radiation oncologist prior to delivery.
Only one additional dosimetry re-plan is payable during the treatment course (at 50% of the Schedule Fee for the associated item) and the clinical need for re-planning must be consistent with the guidance provided in the item descriptor and clearly documented in the patient’s record.
Re-planning items 15912, 15916, 15922 and 15928 cannot be claimed in association with any other service under this subgroup except for the item descriptor that relates.
Image Fusion
Where appropriate, when determining the target volumes and organs at risk for treatment, relevant multi-modality imaging should be used to delineate targets and organs at risk.
Related Items: 15902 15904 15906 15908 15910 15912 15914 15916 15918 15920 15922 15924 15926 15928
Related Items
Category 3 - THERAPEUTIC PROCEDURES
15902 - Additional Information
Megavoltage planning—level 1.1
Simple complexity single‑field radiation therapy simulation and dosimetry for treatment planning, without imaging for field setting, if:
(a) all of the following apply in relation to the simulation:
(i) the simulation is to one site;
(ii) localisation is based on clinical mark‑up and image‑based simulation is not required;
(iii) patient set‑up and immobilisation techniques are suitable for two‑dimensional radiation therapy treatment, with wide margins and allowance for movement; and
(b) all of the following apply in relation to the dosimetry:
(i) the planning process is required to deliver a prescribed dose to a point, either at depth or on the surface of the patient;
(ii) based on review and assessment by a radiation oncologist, the planning process does not require the differential of dose between target, organs at risk and normal tissue dose;
(iii) delineation of structures is not possible or required, and field borders will delineate the treatment volume;
(iv) doses are calculated in reference to a point, either at depth or on the surface of the patient, from tables, charts or data from a treatment planning system
Applicable once per course of treatment
Fee: $725.45 Benefit: 75% = $544.10 85% = $623.05
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15904 - Additional Information
Megavoltage planning—level 1.2
Simple complexity radiation therapy simulation and dosimetry for treatment planning, with imaging for field setting, if:
(a) all of the following apply in relation to the simulation:
(i) treatment set‑up and technique specifications are in preparation for two‑dimensional radiation therapy dose planning;
(ii) patient set‑up and immobilisation techniques are suitable for two‑dimensional radiation therapy treatment where interfraction reproducibility is required;
(iii) imaging datasets are acquired for the relevant region of interest to be planned; and
(b) all of the following apply in relation to the dosimetry:
(i) the two‑dimensional planning process is required to calculate dose to a volume, however a dose‑volume histogram is not required to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the two‑dimensional planning process is not required to maximise the differential between target dose and normal tissue dose;
(iii) the target (which may include gross, clinical and planning targets as a composite structure or field border outline), as defined in the prescription, is rendered as a two‑dimensional structure as field borders or a volume;
(iv) organs at risk are delineated if required, and assessment of dose to these structures is derived from dose point calculations, rather than full calculation and inclusion in a dose‑volume histogram;
(v) dose calculations are calculated using a specialised algorithm, with prescription and plan details approved and recorded with the plan
Applicable once per course of treatment
Fee: $1,062.85 Benefit: 75% = $797.15 85% = $960.45
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15906 - Additional Information
Megavoltage planning—level 2.1
Three‑dimensional radiation therapy simulation and dosimetry for treatment planning, without motion management, if:
(a) all of the following apply in relation to the simulation:
(i) treatment set‑up and technique specifications are in preparation for three‑dimensional planning without consideration of motion management;
(ii) patient set‑up and immobilisation techniques are reproducible for treatment;
(iii) a high‑quality dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and
(b) all of the following apply in relation to the dosimetry:
(i) the three‑dimensional planning process is required to calculate dose to three‑dimensional volume structures and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the three‑dimensional planning process is required to optimise the differential between target dose and normal tissue dose;
(iii) the planning target volume is rendered as a three‑dimensional structure on planning outputs (three‑dimensional plan review, three‑planar sections review or dose‑volume histogram);
(iv) organs at risk are delineated, and assessment of dose to these structures is derived from calculation and inclusion in a dose‑volume histogram
Applicable once per course of treatment
Fee: $1,638.70 Benefit: 75% = $1,229.05 85% = $1,536.30
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15908 - Additional Information
Megavoltage planning—level 2.2
Three‑dimensional radiation therapy simulation and dosimetry for treatment planning with motion management, if:
(a) all of the following apply in relation to the simulation:
(i) treatment set‑up and technique specifications are in preparation for complex three‑dimensional planning with consideration of motion management;
(ii) patient set‑up and immobilisation techniques are reproducible for treatment;
(iii) 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; and
(b) all of the following apply in relation to the dosimetry:
(i) the three‑dimensional planning process is required to calculate dose to three‑dimensional volume structures (which must include structures moving with physiologic processes) and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the three‑dimensional planning process is required to optimise the differential between target dose and normal tissue dose;
(iii) the planning target volume is rendered as a three‑dimensional structure on planning outputs (three‑dimensional plan review, three‑planar sections review or dose‑volume histogram);
(iv) organs at risk are delineated, and assessment of dose to these structures is derived from full calculation and inclusion in a dose‑volume histogram
Applicable once per course of treatment
Fee: $2,649.25 Benefit: 75% = $1,986.95 85% = $2,546.85
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15910 - Additional Information
Megavoltage planning—level 3.1
Standard intensity modulated radiation therapy (IMRT) 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 single‑dose level IMRT planning without motion management;
(ii) patient set‑up and immobilisation techniques are suitable for image volume data acquisition and reproducible IMRT treatment;
(iii) a high‑quality three‑dimensional image volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and
(b) all of the following apply in relation to the dosimetry:
(i) the IMRT planning process is required to calculate dose to a single‑dose level volume structure and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the IMRT planning process optimises the differential between target dose, organs at risk and normal tissue dose;
(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered as volumes and nominated with planning dose objectives;
(iv) organs at risk are nominated as planning dose constraints;
(v) dose calculations and dose‑volume histograms are generated in an inverse planned process using a specialised algorithm, with prescription and plan details approved and recorded with the plan;
(vi) a three‑dimensional image volume dataset is used for the relevant region to be planned and treated with image verification
Applicable once per course of treatment
Fee: $4,142.70 Benefit: 75% = $3,107.05 85% = $4,040.30
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15912 - Additional Information
Megavoltage re‑planning—level 3.1
Additional dosimetry plan for re‑planning of standard intensity modulated radiation therapy (IMRT) treatment, if:
(a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15910 has been prepared; and
(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements
Applicable once per course of treatment
Fee: $2,071.35 Benefit: 75% = $1,553.55 85% = $1,968.95
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15914 - Additional Information
Megavoltage planning—level 3.2
Complex intensity modulated radiation therapy (IMRT) 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 multiple‑dose level IMRT planning or single‑dose level IMRT planning requiring motion management;
(ii) patient set‑up and immobilisation techniques are suitable for image volume data acquisition and reproducible IMRT treatment;
(iii) a high‑quality three‑dimensional or four‑dimensional volume dataset is acquired in treatment position for the relevant region of interest to be planned and treated with image verification; and
(b) all of the following apply in relation to the dosimetry:
(i) the IMRT planning process is required to calculate dose to multiple‑dose level volume structures or single‑dose level volume structures (including structures moving with physiologic processes or requiring precise positioning with respect to beam edges) and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the IMRT planning process optimises the differential between target dose, organs at risk and normal tissue dose;
(iii) all relevant gross tumour targets, clinical target volumes, planning target volumes, internal target volumes and organs at risk are rendered and nominated with planning dose objectives;
(iv) organs at risk are nominated as planning dose constraints;
(v) dose calculations and dose‑volume histograms are generated in an inverse planned process using a specialised algorithm, with prescription and plan details approved and recorded with the plan;
(vi) a three‑dimensional or four‑dimensional image volume dataset is used for the relevant region to be planned and treated, with image verification for a multiple‑dose level IMRT planning or single‑dose level IMRT planning requiring motion management
Applicable once per course of treatment
Fee: $5,953.95 Benefit: 75% = $4,465.50 85% = $5,851.55
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15916 - Additional Information
Megavoltage re‑planning—level 3.2
Additional dosimetry plan for re‑planning of complex intensity modulated radiation therapy (IMRT) treatment, if:
(a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15914 has been prepared; and
(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements
Applicable once per course of treatment
Fee: $2,976.95 Benefit: 75% = $2,232.75 85% = $2,874.55
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15918 - Additional Information
Megavoltage planning—level 4
Intracranial stereotactic radiation therapy (SRT) 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 multiple non‑coplanar, rotational or fixed beam stereotactic delivery;
(ii) precise personalised patient set‑up and immobilisation techniques are suitable for reliable imaging acquisition and reproducible SRT small‑field and ablative treatments;
(iii) a high‑quality three‑dimensional image volume dataset is acquired in treatment position for the intracranial lesions to be planned and treated and verified; and
(b) all of the following apply in relation to the dosimetry:
(i) the planning process is required to calculate dose to single or multiple target structures and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the planning process maximises the differential between target dose, organs at risk and normal tissue dose;
(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered and nominated with planning dose objectives;
(iv) organs at risk are nominated as planning dose constraints;
(v) dose calculations and dose‑volume histograms are generated using a validated stereotactic‑type algorithm, with prescription and plan details approved and recorded with the plan
Applicable once per course of treatment
Fee: $6,676.00 Benefit: 75% = $5,007.00 85% = $6,573.60
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15920 - Additional Information
Megavoltage planning—level 4
Stereotactic body radiation therapy (SBRT) 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 inverse planning with multiple non‑coplanar, rotational or fixed beam stereotactic delivery or intensity modulated radiation therapy (IMRT) stereotactic delivery;
(ii) personalised patient set‑up and immobilisation techniques are suitable for reliable imaging acquisition and reproducible, including techniques to minimise motion of organs at risk and targets;
(iii) small‑field and ablative treatment is used;
(iv) 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, treated and verified (through daily planar or volumetric image guidance strategies); and
(b) all of the following apply in relation to the dosimetry:
(i) the planning process is required to calculate dose to single or multiple target structures and requires a dose‑volume histogram to complete the planning process;
(ii) based on review and assessment by a radiation oncologist, the planning process maximises the differential between target dose, organs at risk and normal tissue dose;
(iii) all relevant gross tumour volumes, clinical target volumes, planning target volumes and organs at risk are rendered and nominated with planning dose objectives;
(iv) organs at risk are nominated as planning dose constraints;
(v) dose calculations and dose‑volume histograms are generated using a validated stereotactic‑type algorithm, with prescription and plan details approved and recorded with the plan
Applicable once per course of treatment
Fee: $6,676.00 Benefit: 75% = $5,007.00 85% = $6,573.60
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15922 - Additional Information
Megavoltage re‑planning—level 4
Additional dosimetry plan for re‑planning of intracranial stereotactic radiation therapy (SRT) or stereotactic body radiation therapy (SBRT) treatment, if:
(a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15918 or 15920 has been prepared; and
(b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements
Applicable once per course of treatment
Fee: $3,338.05 Benefit: 75% = $2,503.55 85% = $3,235.65
(See para TN.2.1, TN.2.2 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15924 - Additional Information
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% = $6,943.90
(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15926 - Additional Information
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% = $6,943.90
(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)
Category 3 - THERAPEUTIC PROCEDURES
15928 - Additional Information
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% = $3,420.75
(See para TN.2.1, TN.2.2, TN.2.9 of explanatory notes to this Category)
Legend
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change