Medicare Benefits Schedule - Note TN.2.1

Level 1.1 Items (Simple or Single Field)

In items 15902 and 15930: Simple or single-field complexity external beam radiation therapy is localised, planned and delivered through a clinical mark-up process without the requirements of simulation, computer or volumetric dosimetry and beam modulation. Patient stabilisation is simple using standard devices. Determination of the treatment volume is by clinical assessment and mark-up with the prescribed dose identified on the surface or at depth. Single-field delivery via wide margins determined through the clinical assessment process will not require image verification. The final dosimetry 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.

Level 1.2 Items (Two-Dimensional Simple or Multiple Field)

In items 15904 and 15932: Simple or multiple-field complexity external beam radiation therapy is localised through a process of either two-dimensional simulation or three-dimensional simulation from an appropriate imaging dataset to identify the treatment region. Patient stabilisation is simple using standard devices.

Planning is based on two‑dimensional planning processes with simple beam shaping but no modulation or inverse planning requirements, optimisation is not required on organs at risk. Multiple-field delivery via multileaf collimator (MLC) shaped beams requires verification. The final dosimetry 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.

Level 2.1 Items (Three-Dimensional without motion management)

In items 15906 and 15934: Three-dimensional standard or multiple-field complexity external beam radiation therapy is localised through a process of three-dimensional simulation (plain film views or volumetric delineation) to identify the treatment region and organs at risk.

Planning is based on three‑dimensional planning processes with simple beam shaping and simple modulation (large-segment field in field, wedges, MLCs or tissue compensation) to deliver a conformal dose distribution and assessment of dose to organs at risk. Multiple-field delivery via MLC shaped beams requires image verification. Examples include three-dimensional planned spine treatments (single or opposed fields) breast tangents without target volumes definition, and image-based planning for electrons. The final dosimetry 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.

Level 2.2 Items (Three-Dimensional with motion management)

In items 15908 and 15936: Three-dimensional complex or multiple-field complexity external beam radiation therapy is localised through a process of three or four-dimensional (three-dimensional volumetric delineation or four-dimensional volumetric delineation with consideration of tumour and organs at risk excursion) simulation to identify the treatment region and organs at risk. Patient stabilisation requires the use of devices to support positional reproducibility. Motion management includes four-dimensional CT, deep inspiration breath hold, deep expiration breath hold, use of manual compression and other methods to account for tumour movement.

Planning is based on three or four-dimensional planning processes with complex beam shaping and modulation (MLC or small-segment field in field) to deliver a conformal dose distribution and assessment and management of dose to organs at risk. Multiple-field delivery via MLC shaped beams requires daily image verification prior to treatment delivery. Consideration for re-planning is not required. The final dosimetry 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.

Level 3.1 Items (Standard IMRT Multiple Field)

In items 15910 and 15938: Standard inverse planned intensity modulated radiation therapy (IMRT) to a single dose level prescription and without motion management is localised through a three-dimensional imaging dataset to identify clinical and planning targets, organs at risk and normal tissue.

Planning is based on delivery to a single-dose level target and includes optimisation of the dose based on assessment of organs at risk doses. This technique involves very sharp dose gradients adjacent to both targets and organs at risk, increasing the consequences of any geometric uncertainty, making daily treatment image verification (Image-guided radiation therapy—IGRT) an essential component of quality IMRT. It is the tumour location, adjacent organs and dosimetry that define the appropriate role for IMRT and support an approach where the clinical circumstances, rather than specific diagnoses, are the most important determinants for using IMRT. Final dosimetry plan is validated by both the radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to treatment delivery.

Level 3.2 Items (Complex IMRT Multiple Field)

In items 15914 and 15940: Complex inverse planned intensity modulated radiation therapy (IMRT) to multiple-dose level prescription or IMRT with motion management is localised through three or four dimensional (volumetric imaging) to identify clinical and planning targets, organs at risk and normal tissue (and tumour and organs at risk excursion in the case of four-dimensional applications).

Planning is based on delivery to multiple-dose level targets or IMRT with motion management and includes optimisation of the dose based on assessment of organs at risk. This technique involves very sharp dose gradients adjacent to both targets and organs at risk, increasing the consequences of any geometric uncertainty, making daily treatment verification (Image-guided radiation therapy—IGRT) an essential component of quality IMRT. In the case of four-dimensional applications, treatment delivery utilises some form of motion management and further complicates the planning, delivery and quality assurance processes. Motion management includes four-dimensional volumetric imaging, deep inspiration breath hold, deep expiration breath hold, use of manual compression and other methods to account for tumour movement. It is the tumour location, adjacent organs and dosimetry that define the appropriate role for IMRT and support an approach where the clinical circumstances, rather than specific diagnoses, are the most important determinants for using IMRT. Pre-treatment quality assurance validation will be required and consideration for re-planning is included. Final dosimetry plan is validated by both the radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to treatment delivery. Small-field fractionated treatment strategies (using either an IMRT or multiple, non-coplanar, rotational or fixed beam delivery) are included in this complexity level.

Level 4 Items (Intracranial Stereotactic Radiation Therapy)

In items 15918 and 15942: Stereotactic radiation therapy delivered using a Therapeutic Goods Administration approved device using specifically calibrated small fields. Dedicated and customised patient positioning, immobilisation and imaging for identification of the treatment volume, surrounding organs at risk and normal tissue. Where relevant formal structured assessment of motion and patient suitability for complex and lengthy delivery may include fixed head frame. Lengthy treatment sessions may require patient education to support positional and physiological control requirements. Dosimetry delivers small-field collimation and shaping of the dose to complex targets. Pre-treatment quality assurance validation will be required and consideration for re-planning is included. Very tight margins and steep dose gradients mandates the use of daily IGRT. Final dosimetry plan is validated by both the appropriately qualified radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to treatment delivery.

Level 4 Items (Stereotactic Body Radiation Therapy)

In items 15920 and 15944: Stereotactic body external beam radiation therapy with or without motion management is localised through a three or four-dimensional simulation to identify clinical and planning targets, organs at risk and normal tissue (and excursion of tumour and organs at risk in the case of four-dimensional applications). Requires dedicated and personalised patient positioning and immobilisation and multi-modality image based targeted identification of the treatment volume, surrounding organs at risk and normal tissue. Lengthy treatment sessions may require patient education to support positional and physiological control requirements. Motion management includes four-dimensional CT, deep inspiration breath hold, deep expiration breath hold, use of manual compression and other methods to account for tumour movement.

Stereotactic body radiation therapy (SBRT) and stereotactic ablative radiation therapy (SABR) are used interchangeably and are defined as high precision, image-guided radiation therapy (IGRT) dose delivery with highly conformal dose and steep dose gradients, with larger doses per fraction, fewer treatments as determined by standard clinical protocols, eg. 5 for prostate treatments or 8 for central lung treatments and including intrafraction motion management where applicable.

For stereotactic treatments this requires on the first day of treatment, a radiation oncologist or trained delegate with documented competencies in stereotactic treatments must be present at the start of the treatment fraction (prior to irradiation) to verify the integrity of the patient set-up at the treatment machine, patient repositioning using image guidance, and directly manage any clinical issues. For subsequent fractions in the same course, the radiation oncologist must be immediately available for critical decision making. Patient specific pre-treatment quality assurance validation may be required and consideration for re-planning and is included. Very tight margins and steep dose gradients mandates the use of daily IGRT. Final dosimetry plan is validated by both the appropriately qualified radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to delivery.

Level 5 Items (Specialised)

In items 15924, 15926, 15946 and 15948: Patient acuity requires multidisciplinary medical and technical support during the simulation and treatment processes (for example, general anaesthetic for complex cases or monitoring for patients receiving Total Body Irradiation). Complex dosimetry requirements are driven by large field or large volume requirements in total skin electron therapy (TSE) or total body irradiation (TBI) cases and highly personalised dosimetry requirements with younger paediatric patients, and patients requiring general anaesthetic or supervised sedation. Clinical and Technical complexity requires prolonged, complex multidisciplinary team involvement and direct involvement in the treatment delivery process; including in vivo dosimetry. Patient specific complex quality assurance validation pre-treatment and during treatment is required and consideration for re-planning is included. Final dosimetry plan is validated by both the radiation therapist and medical physicist, using quality assurance processes, with the plan approved by the radiation oncologist prior to delivery.

Radiation therapy treatment and replanning to correspond with planning

The complexity level of the treatment regimen must be appropriate for the plan (or replan). Accordingly, treatment items must not be billed at higher levels than the complexity level associated with planning (or replanning) item for that site.

Where planning/replanning/treatment is for multiple sites, each site must be clearly identified and differentiated by name in billing notes.

Related Items: 15902 15904 15906 15908 15910 15912 15914 15916 15918 15920 15922 15924 15926 15928 15930 15932 15934 15936 15938 15940 15942 15944 15946 15948

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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: $742.85 Benefit: 75% = $557.15 85% = $640.45

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

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: $1,088.35 Benefit: 75% = $816.30 85% = $985.95

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

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: $1,678.05 Benefit: 75% = $1,258.55 85% = $1,575.65

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

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: $2,712.85 Benefit: 75% = $2,034.65 85% = $2,610.45

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

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: $4,242.10 Benefit: 75% = $3,181.60 85% = $4,139.70

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

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: $2,121.05 Benefit: 75% = $1,590.80 85% = $2,018.65

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

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: $6,096.85 Benefit: 75% = $4,572.65 85% = $5,994.45

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

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: $3,048.40 Benefit: 75% = $2,286.30 85% = $2,946.00

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

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: $6,836.20 Benefit: 75% = $5,127.15 85% = $6,733.80

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

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: $6,836.20 Benefit: 75% = $5,127.15 85% = $6,733.80

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

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: $3,418.15 Benefit: 75% = $2,563.65 85% = $3,315.75

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

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: $7,215.40 Benefit: 75% = $5,411.55 85% = $7,113.00

(See para TN.2.1, TN.2.2 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: $7,215.40 Benefit: 75% = $5,411.55 85% = $7,113.00

(See para TN.2.1, TN.2.2 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: $3,607.70 Benefit: 75% = $2,705.80 85% = $3,505.30

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

Megavoltage treatment—level 1.1

Radiation therapy for simple, single‑field treatment (including electron beam treatments), if:

(a) the treatment does not use imaging for field setting; and

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

(c) the treatment is delivered to implement a one‑dimensional plan; and

(d) a two‑dimensional single‑field treatment delivery mode is utilised

Applicable up to twice per plan per day

Fee: $93.45 Benefit: 75% = $70.10 85% = $79.45

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

Megavoltage treatment—level 1.2

Radiation therapy and image verification for simple treatment, with imaging for field setting, if:

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

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a two‑dimensional plan, and

(c) two‑dimensional treatment is delivered; and

(d) image verification decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $116.40 Benefit: 75% = $87.30 85% = $98.95

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

Megavoltage treatment—level 2.1

Radiation therapy and image verification for three‑dimensional treatment, without motion management, if:

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

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a standard three‑dimensional plan; and

(c) three‑dimensional treatment is delivered; and

(d) image verification decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $262.10 Benefit: 75% = $196.60 85% = $222.80

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

Megavoltage treatment—level 2.2

Radiation therapy and image verification for three‑dimensional treatment, if:

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

(b) image‑guided radiation therapy (IGRT) imaging is used to implement a complex three‑dimensional plan; and

(c) complex three‑dimensional treatment is delivered with management of motion; and

(d) image decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $285.10 Benefit: 75% = $213.85 85% = $242.35

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

Megavoltage treatment—level 3.1

Standard single‑dose level intensity modulated radiation therapy (IMRT) treatment and image verification, without motion management, if:

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

(b) image‑guided radiation therapy (IGRT) imaging is used to implement an IMRT plan at a level that is equivalent to or higher than that described in item 15910

Applicable up to twice per plan per day

Fee: $285.10 Benefit: 75% = $213.85 85% = $242.35

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

Megavoltage treatment—level 3.2

Complex multiple‑dose level intensity modulated radiation therapy (IMRT) treatment, or single‑dose level IMRT treatment requiring motion management, and image verification, if:

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

(b) image‑guided radiation therapy (IGRT) imaging is used (with motion management functionality if required) to implement an IMRT plan at a level that is equivalent to or higher than that described in item 15910; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable up to twice per plan per day

Fee: $313.60 Benefit: 75% = $235.20 85% = $266.60

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

Megavoltage treatment—level 4

Intracranial stereotactic radiation therapy treatment and image verification, if:

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

(b) image‑guided radiation therapy (IGRT) or minimally invasive stereotactic frame localisation is used to implement an intracranial stereotactic treatment plan at a level described in item 15918; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable once per day

Fee: $808.30 Benefit: 75% = $606.25 85% = $705.90

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

Megavoltage treatment—level 4

Stereotactic body radiation therapy (SBRT) treatment and image verification, if:

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

(b) image‑guided radiation therapy (IGRT) is used (with motion management functionality if required) to implement a stereotactic body radiation therapy plan at a level described in item 15920; and

(c) radiation field positioning requires accurate dose delivery to the target; and

(d) image decisions and actions are documented in the patient’s record

Applicable once per day

Fee: $808.30 Benefit: 75% = $606.25 85% = $705.90

(See para TN.2.1, TN.2.3 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 to implement a treatment plan with general anaesthetic or sedation supervised by an anaesthetist

Applicable once per day

Fee: $929.55 Benefit: 75% = $697.20 85% = $827.15

(See para TN.2.1, TN.2.3 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

Applicable up to twice per day

Fee: $929.55 Benefit: 75% = $697.20 85% = $827.15

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