Medicare Benefits Schedule - Note TN.2.3

Multiple treatment sites at one attendance (15930 to 15948)

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. Sites must be clearly identified and differentiated by name in billing notes (e.g., Breast, Pelvis, Brain). For each site the complexity level of the treatment regimen must match the corresponding complexity level associated with planning for that site.

Definition of multiple treatment sites 

1.       locoregional and/or distant disease under one diagnosis treated under multiple separate prescription plans, or

2.       synchronous primaries with each treatment prescribed under separate diagnosis.

Treatments requiring general anaesthetic

Items 15918 and 15948 apply to all patients requiring general anaesthetic or sedation supervised by an anaesthetist for treatment delivery. For patients who do not require general anaesthetic or supervised sedation then other appropriate items should be used.

Radiation oncologist attendance

For all treatments, a radiation oncologist should be available to physically review patients when required.

For complex treatments, a radiation oncologist should be immediately available for critical decision making.

For highly complex treatments, such as stereotactic treatments, a radiation oncologist or trained delegate with documented competencies in stereotactic treatments should 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, a radiation oncologist must be immediately available for critical decision making.

Motion management

Motion management is the use of additional technology to ensure the dose to the target is not compromised by physiological motion or the dose to a critical organ-at-risk adjacent to the target is minimised. This includes:

(a)     Reducing physiological motion (for example breath hold); or

(b)     Quantifying physiological motion (for example 4D-CT or 4D-CBCT); or

Using technology to detect motion and actively control treatment or simulation.

Related Items: 15930 15932 15934 15936 15938 15940 15942 15944 15946 15948

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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 with a one‑dimensional plan; and

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

Applicable once per plan per day

Fee: $91.25 Benefit: 75% = $68.45 85% = $77.60

(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 once per plan per day

Fee: $113.65 Benefit: 75% = $85.25 85% = $96.65

(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 once per plan per day

Fee: $255.95 Benefit: 75% = $192.00 85% = $217.60

(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 once per plan per day

Fee: $278.40 Benefit: 75% = $208.80 85% = $236.65

(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 a standard IMRT plan described in item 15910

Applicable once per plan per day

Fee: $278.40 Benefit: 75% = $208.80 85% = $236.65

(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 a complex IMRT plan described in item 15914; 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 plan per day

Fee: $306.25 Benefit: 75% = $229.70 85% = $260.35

(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 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: $789.35 Benefit: 75% = $592.05 85% = $690.65

(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 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: $789.35 Benefit: 75% = $592.05 85% = $690.65

(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 with general anaesthetic or sedation supervised by an anaesthetist

Applicable once per plan per day

Fee: $907.75 Benefit: 75% = $680.85 85% = $809.05

(See para TN.2.1, TN.2.3, TN.2.9 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; and

(c) image‑guided radiation therapy (IGRT) is used (with motion management functionality, if required) to implement:

(i) three‑dimensional radiation therapy; or

(ii) intensity modulated radiation therapy (IMRT) (including multiple non‑coplanar, rotational or fixed beam treatment); or

(iii) total skin electrons (TSE) where there is individualised treatment

Applicable once per day

Fee: $907.75 Benefit: 75% = $680.85 85% = $809.05

(See para TN.2.1, TN.2.3, TN.2.9 of explanatory notes to this Category)