Summary & Overview
CPT 77431: Radiotherapy Management for One- or Two-Fraction Courses
CPT code 77431 represents professional management of a complete course of radiotherapy delivered in one or two fractions. It identifies services provided by radiation oncologists when they direct, coordinate, and supervise a focused, short-course regimen of external beam radiation. Nationally, this code is relevant for cancer care pathways that use hypofractionated or single-fraction treatments for palliative or select definitive indications and affects billing, utilization patterns, and care coordination across payers.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise account of what the code covers clinically, typical sites of service, and common modifiers used with this service. The publication also outlines benchmarks and payer coverage considerations, coding and billing implications for short-course radiotherapy, and clinical context where one- or two-fraction regimens are applied.
Data not available in the input is clearly noted where applicable, and the content focuses on national policy and coding implications rather than state-specific rules.
Billing Code Overview
CPT code 77431 describes management of a complete course of radiotherapy when treatment is delivered in one or two small doses (fractions), which may be administered over a number of weeks. This procedure denotes the professional services for overseeing and directing the patient’s external beam radiation therapy plan through its entirety when fractionation is limited to one or two fractions.
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Service type: Radiotherapy treatment management for single- or two-fraction courses
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Typical site of service: Radiation oncology clinic or hospital outpatient radiation therapy department
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a confirmed localized malignancy (for example, early-stage breast cancer or prostate cancer) referred for fractionated external beam radiotherapy. The radiation oncologist conducts an initial consultation including history, physical exam, review of diagnostic imaging (CT/MRI/PET), and multidisciplinary discussion. A simulation session is scheduled to obtain a CT simulation with immobilization devices and to mark set-up references. Treatment planning is performed by the radiation oncologist and medical physicist to delineate target volumes and organs at risk, generate dose-volume constraints, and create a treatment plan. The patient then receives daily or alternate-day fractions over several weeks; the physician manages the complete course of radiotherapy, documents weekly on-treatment visits addressing toxicity, assesses response, and modifies the plan or provides treatment breaks as needed. Typical site of service is an outpatient radiation oncology clinic or hospital-based radiation therapy department where linear accelerator-based external beam radiotherapy is delivered. Typical service type is physician global management of a fractionated radiotherapy course, including supervision of simulation, planning, verification, and on-treatment management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician professional portion of a service separate from the technical component. |