Processing radiation oncology 011-43010150

From 1 July 2024 - Radiation oncology planning, re-planning, and treatment items

Table 1

Type	Planning and Re-planning Items	Treatment items	Acceptable text	LSPN required
Subgroup 1 Targeted Intraoperative radiation therapy	Not applicable	15900	Left Breast Right Breast (one per breast per lifetime)	Yes
Subgroup 2 Megavoltage	15902-15928	15930-15948	Full anatomical site	Yes
Subgroup 3 Kilovoltage	15950	15952-15956	Full anatomical site	Yes
Subgroup 4 Brachytherapy	15970-15980	15958-15968, 15982 and 15984	Full anatomical site	Yes

From July 2024 - Initial treatment item and additional site item

Table 2: this table shows the initial treatment item and additional site item. When more than one initial item is claimed on the same date of service, the claim must clearly identify the full anatomical name of each separate site.

Item	Anatomical site	Equipment number	LSPN
15952	One anatomical site	Yes	Yes
15954	Two or more anatomical sites (for the subsequent sites)	Yes	Yes

Before 1 July 2024 - Text requirements and derived fee items

Table 2: this table shows the appropriate text/notes needed when processing radiation oncology items. It shows which additional field derived fee item matches each single field base item.

Type	Base item and body area	Derived fee item (additional field 2-5 fields)	Separate times, occasions or attendances	Multiple fields/s
Subgroup 1-Superficial	15000	15003	Yes	Yes
Subgroup 1-Superficial	15006	15009	Yes	Yes
Subgroup 2- Orthovoltage	15100	15103	Yes	Yes
Subgroup 2- Orthovoltage	15106	15109	Yes	Yes
Subgroup 2- Orthovoltage	15112	15115	Yes	Yes
Subgroup 3-Megavoltage	15211	15214	Yes	Yes
Subgroup 3-Megavoltage	15215 lung	15230	Yes	Yes
Subgroup 3-Megavoltage	15218 prostate	15233	Yes	Yes
Subgroup 3-Megavoltage	15221 other	15236	Yes	Yes
Subgroup 3-Megavoltage	15224 other	15239	Yes	Yes
Subgroup 3-Megavoltage	15245 lung	15260	Yes	Yes
Subgroup 3-Megavoltage	15248 prostate	15263	Yes	Yes
Subgroup 3-Megavoltage	15251 breast	15266	Yes	Yes
Subgroup 3-Megavoltage	15254 other	15269	Yes	Yes
Subgroup 3-Megavoltage secondary site	15227	15242	Yes	Yes
Subgroup 3-Megavoltage secondary site	15257	15272	Yes	Yes

Before 1 July 2024 - Text requirements and planning items

Table 3: this table outlines the appropriate text/note for planning items.

Type of therapy	Planning Item	Time dependency	Note/Text required
Brachytherapy	15536 15539	2 services in a day	New tumour
Radiation Dosimetry	15518 15521 15524 15527 15530 15533	2 services in a day	New tumour
Dosimetry for 3D conformal radiotherapy	15556 15559 15562	2 services in one day	New tumour
Intensity-Modulated Radiation Therapy	15565	One services in 42 days	Separate episode of care

Before 1 July 2024 - FAQs

Table 4

Item	Description
1	What does the word attendance mean in relation to radiotherapy items? The word attendance relates to a single visit radiotherapy treatment. At each attendance, a fraction of the treatment course is delivered to the patient.
2	What does the word field mean in relation to radiotherapy items? The word field refers to the area irradiated in a single application of X rays. See the Resources page in Radiation oncology (radiotherapy) for more details.
3	What text/notes are acceptable to indicate separate occasions/separate attendances? The health professional must provide text or notes that state the services were performed at separate attendances. This could be 'separate attendance' or 'separate occasion' or the times on the same day, for example, 9 am and 3:45 pm.
4	What text/notes are required when multiple radiotherapy items are performed on the same occasion? This will depend on the radiotherapy treatment item numbers that are being claimed. If multiple primary sites apply, and a patient has more than one separate and distinct primary tumour, then the service text/note must include the different sites. For example, right and left leg.
5	Can planning item 15565 be claimed more than once in a 42 day period? Item 15565 can only be claimed once per day and once per 42 day period. Item 15565 can be claimed more than once per 42 days if text is provided stating 'separate episode of care'.
6	Can you claim item 15275 multiple times in a day? Item 15275 is the only treatment item that can be claimed with planning item15565. Item 15275 can be claimed once per attendance and can be claimed more than once per day if more than one treatment is required. This occurs with hyper fractionated treatment.
7	What is the appropriate time field to pay multiple services? There is a difference between transmission time (service time) and time noted in the Text field. It is the health professional's responsibility to provide the correct text/note. Transmission time is the time recorded by the system if a transmitted claim has been sent. It is displayed in the Service Time field Free text times are when the health professional manually enters the time into the text field If the only text is the transmission time, for example, 2 or 3 seconds/minutes apart, reject the items. If the health professional provides an individual treatment/attendance times in the free text, pay the items.
8	How often can a simulation item and a verification item be claimed? A simulation item can be claimed once per planning item. A verification item can only be claimed once per treatment attendance, no matter how many treatment sites are verified at that attendance.

Return messages

Table 5: this table contains return messages associated with radiation oncology processing.

Return message	Description and resolution
3-CHK FLDS	Derived fee item keyed, minimum allowable number of fields is 2 If a radiotherapy derived fee item is keyed, the minimum allowable number of fields/sites is 2. This includes the base item plus any associated derived fee item. a radiotherapy derived fee item has been entered and the number of fields/sites is only one, and/or the associated base item is not present: check keying If the number keying is incorrect: correct any errors, and press [Enter] If the account/invoice/claim quotes one field/site and/or the base item is missing: Reject the derived fee item with RSN 129 If the base item is not immediately above the derived fee item: online claims - reject the claim with RSN 172, or manual claims - re-key with correct order and pay the claim
3-RAD ONC	More than one radiation oncology base item More than one radiation oncology base item, and one or more radiation oncology derived fee items display for the same date of service. Check keying. If the numbers are: incorrect, correct any errors and press [Enter] correct, determine whether benefit should be paid for all services involved If all services are payable: manual claims - key a new claim for subsequent base and derived fee items electronic claims - pay the first base and derived fee item and reject any subsequent items with RSN 640 If the benefit is not payable for one or more of the items involved, reject the appropriate item with RSN 108.
1-EQPT NOT	Item claimed requires specific equipment registered on LSPN Register The item claimed requires a specific equipment type to be registered on the LSPN Register. Check keying. If the number is: incorrect, correct any errors and press [Enter] correct, reject the service with RSN 514
3-RADT GT	Maximum allowable field/sites for derived fee items Radiation oncology derived fee items have a maximum number of allowable fields/sites. The maximum number of fields/sites can be viewed on the Fee screen in QITI. If more than the allowable number of fields is claimed: Check the keying, correct any errors and press [Enter] If keying is correct, reject the claim with RSN 127 or 713

Contact details

Medicare and Aged Care - Local Peer Support (LPS)

External links

MBS Online

MBS Online - Medicare Benefits Schedule - Note TN.2.2

Cancer Australia - Glossary of terms used in radiation oncology

Cancer Australia - Radiation therapy

Operational Information