Medicare Benefits Schedule - Note TN.2.4

Planning and treatment of multiple sites (items 15950, 15952, 15954)

Where patients are being treated with radiation therapy to multiple separate sites of disease at one attendance, each treatment site must be documented in a separately prescribed plan. Each site must be clearly identified and differentiated with a unique name in billing notes.

Kilovoltage treatment (15952, 15954, 15956)

15952 is billed when one site only is being treated at the attendance.

Treatment to 2 or more sites during the same attendance should be billed as follows:

• 15952 for the first site, and
• 15954 for each additional site

15956 is billed when treatment is delivered to orbital structures where there is placement of an internal eye shield. Items 15952 and 15954 cannot be billed for treatment to orbital structures.

Planning validation

The final treatment plan is validated by a radiation therapist or medical physicist, using robust quality assurance processes, with the plan approved by the radiation oncologist prior to delivery.

Related Items: 15950 15952 15954 15956

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Kilovoltage planning

Simple complexity single‑field radiation therapy simulation and dosimetry for treatment planning without imaging for field setting, if:

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

(i) localisation is based on clinical mark‑up and image‑based simulation is not required;

(ii) 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: $208.60 Benefit: 75% = $156.45 85% = $177.35

(See para TN.2.4 of explanatory notes to this Category)

Delivery of kilovoltage radiation therapy (50 kV to 500 kV range) to one anatomical site (excluding orbital structures where there is placement of an internal eye shield)

Fee: $56.15 Benefit: 75% = $42.15 85% = $47.75

(See para TN.2.4 of explanatory notes to this Category)

Delivery of kilovoltage radiation therapy (50 kV to 500 kV range) to each additional anatomical site following delivery to one anatomical site treated under item 15952 (excluding orbital structures where there is placement of an internal eye shield)

Fee: $22.55 Benefit: 75% = $16.95 85% = $19.20

(See para TN.2.4 of explanatory notes to this Category)

Delivery of kilovoltage radiation therapy (50 kV to 500 kV range) to orbital structures where there is placement of an internal eye shield

Fee: $69.05 Benefit: 75% = $51.80 85% = $58.70

(See para TN.2.4 of explanatory notes to this Category)