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    v1.0.30
    OpenPayerBilling CodesRadiation Treatment ManagementCPT cpt-77435-stereotactic-body-radiotherapy-treatment-management
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    CPT 77435: Stereotactic Body Radiotherapy Course (≤5 Fractions)

    Medicare pays $658 on average nationally for this procedure.

    CPT code 77435 describes management of a complete course of stereotactic body radiotherapy (SBRT) using a three-dimensional coordinate system to target and destroy small extracranial lesions with externally generated ionizing radiation; the service covers a full course of treatment delivered in up to five fractions and typically is provided in an ambulatory radiation oncology or hospital outpatient setting as a course-of-care radiation therapy service.

    For related coverage guidance, see recent payer policy updates: Radiation oncology coverage and treatment delivery guidelines, Proton Beam Therapy, Radiation and Oncologic Procedures.

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 68-year-old patient with a solitary 2.5 cm primary lung tumor or an oligometastatic lesion to the liver is referred to radiation oncology for stereotactic body radiotherapy (SBRT). The radiation oncologist performs a consultation, reviews cross-sectional imaging (CT and/or PET-CT), assesses performance status and comorbidities, and determines SBRT is appropriate because the lesion is small, well‑circumscribed, and suitable for highly conformal high‑dose per fraction treatment delivered in five or fewer fractions. Treatment planning includes simulation with immobilization and 3‑dimensional CT simulation, often with 4D motion assessment for thoracic or upper abdominal targets. Target delineation and organs‑at‑risk contouring occur in the treatment planning system, followed by creation and quality assurance of stereotactic plans using image‑guided delivery techniques (cone‑beam CT, kV imaging, or fiducial tracking). On treatment days the team performs image guidance, verifies target alignment, and delivers each fraction. Typical site of service is an outpatient radiation oncology clinic or specialized ambulatory radiation center; inpatient delivery is uncommon but may occur for select hospitalized patients. The service type is high‑complexity, definitive ablative radiotherapy delivered in a short course (≤5 fractions) targeting one or more extracranial lesions using a stereotactic coordinate system.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    77295Radiation therapy dose planning, complex, includes dose–volume histograms when performed; complex planning for stereotactic proceduresUsed during pre‑treatment planning to generate SBRT dose plans and DVH analysis.
    77427Radiation treatment management, 5 fractionsRepresents daily management for a course of radiation therapy; may be used for conventional fraction courses but differs from SBRT billing structure.
    77373Special medical radiation physics consultation, treatment devices, or brachytherapy source handling (complex physics)Used for specialized physics procedures, QA, or special dosimetry associated with SBRT planning and delivery.
    77290Therapeutic radiology simulation-aided field setting; simple/complex (as applicable)Represents simulation procedures such as 3D CT simulation used before SBRT.
    A9528Image guidance or device tracking codes are often performed (non‑CPT HCPCS example)Image guidance and motion management are integral to SBRT delivery; specific image‑guidance CPT/HCPCS codes are billed per payer policy.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    208100000X
    363L00000X
    207RX0202X
    1835P1400X
    261QI0500X
    261QE0700X
    2471B0102X

    Related Payer Policy Updates

    Specialty: Radiation Oncology1 / 2

    10 rows

    PolicyPayerEffective Date
    Radiation oncology coverage and treatment delivery guidelinesevicore2026-11-05
    Proton Beam Therapyuniversityofutahhealthplans2026-10-25
    Radiation and Oncologic ProceduresUnitedHealthcare2026-09-01
    Electronic Brachytherapy for Nonmelanoma Skin CancerBluecross Idaho2026-07-30
    Surface Radiation Therapy for Treatment of Non-Melanoma Skin Cancereocco2026-07-09
    Radiofrequency Ablation of Tumors Outside the LiverProvidence Health Plan2026-07-01
    Therapeutic Radiopharmaceuticals in Oncology (Lutathera, Pluvicto, Xofigo) Coverage CriteriaBlue Cross Blue Shield - North Carolina2026-07-01
    Intensity Modulated Radiation TherapyAmbetter Georgia2026-06-01
    Irreversible Electroporation (IRE) of Tumors Other Than LiverBlue Cross Blue Shield - Rhode Island2026-06-01
    Irreversible Electroporation (IRE) — NanoKnife (Preauthorization Required)Blue Cross Blue Shield - Nebraska2026-06-01

    Related Codes

    CPT-77427-RADIATION-THERAPY-MANAGEMENT-EXTERNAL-BEAM

    CPT 77427: Radiation Treatment Management

    CPT-77431-RADIOTHERAPY-MANAGEMENT-ONE-TWO-FRACTION-COURSE

    CPT 77431: Management of Short-Course Fractionated Radiotherapy

    CPT-77432-SINGLE-SESSION-STEREOTACTIC-RADIOSURGERY-PROFESSIONAL

    CPT 77432: Stereotactic Radiosurgery, Single Session (Professional Component)

    CPT-77437-SUPERFICIAL-RADIATION-THERAPY-PER-FRACTION

    CPT 77437: Superficial Radiation Therapy, Per Fraction

    CPT-77438-ORTHOVOLTAGE-SURFACE-RADIATION-THERAPY-SINGLE-FRACTION

    CPT 77438: Orthovoltage Surface Radiation Therapy, Single Fraction

    CPT-77439-ULTRASOUND-GUIDED-SRT-FIELD-PLACEMENT

    CPT 77439: Ultrasound-Guided SRT Field Localization for Cutaneous Tumors

    CPT-77469-INTRAOPERATIVE-RADIATION-THERAPY-IORT-DURING-SURGERY

    CPT 77469: Intraoperative Radiation Therapy Management

    CPT-77470-SPECIAL-RADIOTHERAPY-MANAGEMENT

    CPT 77470: Special Radiotherapy Procedures Requiring Additional Management

    CPT-77499-UNLISTED-THERAPEUTIC-RADIOLOGY-TREATMENT-MANAGEMENT

    CPT 77499: Therapeutic Radiology Treatment Management, Unlisted

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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