Radiation oncology (radiotherapy) 011-42060100

Radiation oncology is a medical speciality that involves the controlled use of radiation to treat various forms of cancer.

Radiation therapy (radiotherapy) is the term used to describe the actual treatment delivered by the radiation oncology team. Radiotherapy services are often referred to as radiation oncology services.

The Resources page contains a list of terminology.

Radiotherapy services are in MBS Category 3, Group T2 - Radiation Oncology.

Mainframe return messages

Some return messages in mainframe include the term 'fields'. Relevant full return messages have been amended for fields/sites. Fields were relevant to derived fee services before 1 July 2024. The number of anatomical sites is relevant to services from 1 July 2024. Other existing return messages also have new content. Service Officers must read and action all return messages to ensure claims are correctly assessed and paid.

Radiotherapy and consultations

Some radiotherapy treatment services do not apply if they are provided at the same time as, or in connection with a consultation. Therefore separate benefits for consultations may not be payable.

Implantation of radioactive substances

Where a surgeon and a radiotherapist are both associated in the theatre in an operation involving insertion of radioactive material, benefits are payable in full for both the radiotherapy item and the appropriate surgical item in Group T8 of the Schedule.

Benefits are not payable for assistance at the implantation of a radioactive substance covered by Group T2 items. However, when performed in association with an operation (Group T8), a benefit for assistance at the operation is payable.

See MBS Online explanatory notes for Category 3.

The Resources page contains a link to MBS Online.

From 1 July 2024, radiation oncology services have changed to implement the Australian Government's response to the MBS Review Taskforce (the Taskforce) recommendations. The Taskforce Oncology Clinical Committee recommended a restructure of MBS services for radiation oncology in Group T2. Services align better with contemporary clinical practice and improve health outcomes for patients.

Transitional arrangements

All radiation oncology items before 1 July 2024 (with the exception of item 15900) have ended and were replaced with new items from 1 July 2024. There is no process to:

• "phase out" old items while "phasing in" new items
• make existing items available next to, or together with the new items

Treatment methods, subgroups and types of services

Methods of treatment and subgroups

Radiotherapy treatment is delivered by 4 main methods and each are in their own subgroup:

• 1 - Targeted intraoperative radiation therapy
• 2 - Megavoltage
• 3 - Kilovoltage
• 4 - Brachytherapy

Targeted intraoperative radiation therapy consists of item 15900, this is the only remaining item from the old services. It is for treatment to a breast and applies once only per side in a lifetime. There is no plan item in this subgroup.

Megavoltage is an external radiotherapy method and is tiered by 5 levels of planning and treatment. Megavoltage radiotherapy:

• is the primary method of treatment
• there are re-planning items available for levels 3, 4 and 5
• levels 1-3 have sub-levels, for example 1.1 and 1.2
• treatment items are:
• once per plan per day, or
• once per day
• verification is included in treatment items, except item 15930 which does not require verification
• treatment and re-planning should correspond with planning. Refer to the end of MBS explanatory note TN.2.1

The Resources page has a link to MBS Online.

Kilovoltage has the only radiotherapy derived fee item. Item 15952 is for treatment to one anatomical site. If 2 or more anatomical sites are treated within the same plan, derived fee item 15954 applies. In scenarios where 2 or more sites are treated, base item 15952 must be in the same claim as item 15954. These claims must include text or notations against items:

• 15952 indicating the anatomical site name in full
• 15954 indicating the number of additional anatomical sites treated

To ensure correct benefits are paid, Service Officers must key the number of additional anatomical sites for item 15954 when processing claims. See Processing radiation oncology.

Brachytherapy has 3 levels of planning and replanning:

• simple
• intermediate
• complex

There is a single item for treatment and a separate item for treatment verification.

Brachytherapy includes items for construction and for insertion of moulds.

Types of service

Radiotherapy is mainly split into 2 types of service:

• plans
• treatment

The Resources page contains a table listing the items in each subgroup, a list of terminology and external links, which include MBS Online and a glossary.

Course of treatment

When deciding on a course of treatment the health professional considers the patient's:

• type of cancer
• position of the cancer in their body
• other treatment they have had, are having, or is planned for them
• general health and fitness

A course of treatment could include some or all of the following:

• insertion of the applicator (mould), for brachytherapy only
• plan (including, simulation and dosimetry)
• treatment
• verification (which may be in treatment item or separate, depending on treatment method)
• re-planning, if required and if available

Radiotherapy planning

Computerised planning, simulation and dosimetry

Before starting radiation therapy, a treatment plan is created for each patient's individual circumstances.

A plan could consist of any or all the below:

• where to direct the treatment (body areas)
• depth in terms of superficial or deep therapy
• dosage needed, that is, how much and how often

Dosimetry and simulation are included in the plan items.

There are 7 re-planning items as well as megavoltage and brachytherapy planning items.

One plan per course of treatment

For each course of treatment Medicare benefits are only payable for one:

• plan
• replan, where it is required for the treatment of the patient and replan items are available for the treatment type

Treatment may be delivered over weeks or months.

Brachytherapy has multiple plans. All or most service items could be done at every attendance. Therefore, these courses of treatment can be much shorter, sometimes lasting a couple of days. See Medicare Benefits Schedule explanatory note EN.26. The Resources page has a link to MBS Online.

Multiple plans

There are circumstances where more than one treatment plan may be needed at the same time. There is a course of treatment for each plan.

These include where:

• the patient requires separate plans and treatment for distinct and separate anatomical sites
• a plan for brachytherapy (radiation placed inside the body) is needed in the same course of treatment as megavoltage or kilovoltage (external rays)
• a new tumour site is identified during the original course of treatment and a new plan is needed to treat this tumour. This forms a new course of treatment

If a claim is received for a second planning item for the same date of service as another, service text is required.

Where patients require plans for radiotherapy treatment to multiple separate sites of disease at one attendance, each treatment site must be documented in a separately prescribed plan. Claim text or notations must clearly state the separate anatomical sites by name (for example left breast, right breast, pelvis, brain).

Restrictions must be overridden if claims include acceptable text. Stating 'new tumour' or 'separate site' is not acceptable and restrictive claims only quoting this text must be rejected.

Note: it is important that health professionals provide sufficient information on accounts to support the payment of benefit if they claim more than one planning episode relating to separate treatments.

The Resources page contains a table listing the items and relevant details.

Radiotherapy treatment

Appropriate text

Where patients require plans for radiotherapy treatment to multiple separate sites of disease at one attendance, each treatment site must be documented in a separately prescribed plan. Claim text or notations must clearly state the separate anatomical sites by name (for example left breast, right breast, pelvis, brain).

For item 15954, text must state the number of subsequent sites treated. For example, '7' or '3'.

Restrictions must be overridden if claims include acceptable text. See assessing rulings on QITI for more details.

Stating 'new tumour', 'separate episodes of care', 'separate times', 'AM', 'PM' or 'separate site' is not acceptable and restrictive claims only quoting this text must be rejected.

Limits to services

Many treatment item descriptions include terms about how often they can be performed.

If an item description includes the term:

• applicable once per plan per day the restriction can be overridden if the claim includes appropriate text/notation for each separate plan that refers to each anatomical site, for example breast, pelvis, brain
• applicable once per day then the Medicare benefit is only payable once for that item each day

The Resources page contains a table listing the items and relevant details. See also the Resources page in Processing radiation oncology for more tables.

Radiotherapy planning

Computerised planning and simulation items - Subgroup 5 (15500 - 15565 and 15850)

Before starting radiation therapy, a treatment plan is created for each patient’s individual circumstances.

A plan could consist of any or all the below:

• where to direct the treatment (body areas)
• depth in terms of superficial or deep therapy
• dosage needed, that is, how much and how often

Radiotherapy planning items have 2 distinct aspects to them:

• Simulation - determines the field settings used for treatment. Requires the use of specialised machinery (for example, Isocentric X-ray machine, Computed Tomography (CT) scanner, megavoltage machine). Simulation or field setting items are within the range (15500 – 15515 and 15850) whichever method is used
• Planning or radiation dosimetry – calculates the dose of radiation for the patient’s treatment including how much radiation delivered to each field. Planning is done on specialised computers which may be linked to a tomography machine. Planning items are in the range (15518-15539, 15556- 15565)

Only one simulation item (15500-15515, 15550- 15555, 15850) can be claimed per treatment plan (15518-15539, 15556- 15565).

Field setting and dosimetry do not have to be performed together for benefits to be paid. Providing that the service does not relate to re-planning, benefits are payable.

One plan per course of treatment

Only one plan attracts Medicare benefits in a course of treatment. Treatment may be delivered over weeks or months.

At commencement of treatment, the plan includes all identified tumour targets necessary. Planning items cannot be paid per tumour site and text stating ‘separate tumour site’ or ‘separate tumours’ is not valid reason to override a restriction for 2 planning items.

Benefits are not payable for re-planning, as the schedule fees for planning items include a loading to cover any replans in a course of treatment.

Multiple planning episodes

There are circumstances where more than one treatment plan may be needed within one course of treatment.

These circumstances include:

• Where a plan for Brachytherapy (radiation placed inside the body) is needed in the same course of treatment as Megavoltage or teletherapy (external rays)
• Where a new tumour site is identified during the original course of treatment and a new plan is needed to treat this tumour. This forms a separate episode of care or new course of treatment

If a claim is received for a second planning item for the same date of service as another or within one course of treatment, service text is required. Stating new tumour or separate episode of care indicates that a new plan was needed and the restriction can be overridden.

Note: it is important that health professionals provide sufficient information on accounts to support the payment of benefit where they claim more than one planning episode relating to separate treatments.

Planning item 15565

Item 15275 is the only appropriate treatment item under an IMRT plan item 15565.

Where other unrelated or extra treatment is needed within 42 days of this plan 15565, the health professional needs to include the text not in association with 15565 before a benefit is paid.

Breast Boost

Where a more targeted or additional dose of radiation is needed at the end of a treatment plan relating to breast items 15215-15272, appropriate text is required:

• 'breast boost- not associated with item 15565'
• 'not in association with 15565'

Breast boost is not always needed and based on how the patient responds to the dosage schedule of the original plan.

Treatment verification Subgroup 7 (items 15700, 15705, 15710 and 15715)

Treatment verification is a quality assurance procedure designed to facilitate accurate and reproducible delivery of radiotherapy/brachytherapy to the prescribed site/s or regions of the body as defined in the radiotherapy treatment plan.

Treatment verification uses the capture and assessment of appropriate images using X-rays, CT or ultrasound.

Note: x-rays taken during simulation do not attract benefit.

Verification items are only payable once per attendance, irrespective of the number of treatment sites verified at that attendance.

Level of benefits

The level of benefits for radiotherapy treatment items 15000 - 15272 are affected by:

• the number of fields irradiated
• the number of times treatment is given

At each treatment, radiotherapy can be delivered to a tumour site in:

• a single field (at one angle)
• multiple fields (at more than one angle)

Items 15000 - 15272 are classified as base or derived fee items.

• A base item is used for the irradiation of one field. Each base item has a corresponding derived fee item
• When 2 or more fields are irradiated, the corresponding derived fee item is also claimed. Medicare benefits are not payable for irradiation of more than 5 additional fields. Derived fee items require a corresponding base fee item to also appear on the invoice for a benefit to be paid

Derived fee items are rejected if submitted without a base item number.

Note: where a claim is received for treatment of more than one field, benefits for both items are paid together under the aggregate/derived fee item only, not the base item number.

See Processing radiation oncology for more information on base and derived fees.

Rotational therapy

Treatment by rotational therapy (where the radiation dose is delivered continuously as the treatment machine rotates) is considered to be the equivalent to the irradiation of 3 fields.