Summary & Overview
CPT 77435: Stereotactic Body Radiotherapy Treatment Management
CPT code 77435 designates management of a complete course of stereotactic body radiotherapy (SBRT) for one or more lesions outside the brain and spinal cord, delivered in up to five fractions. This code captures the professional management responsibility for planning and overseeing highly focused external beam radiation treatments that use a three-dimensional coordinate system to target small lesions. Nationally, SBRT has grown as an option for localized tumors where precision and limited treatment sessions are clinically advantageous, making accurate coding and coverage critical for payment and quality reporting.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare. Readers will find a concise overview of the clinical context for SBRT under this code, a summary of common billing modifiers used with complex radiation oncology services, and notes on typical sites of service. The publication highlights benchmarking elements and policy-relevant observations such as utilization patterns, documentation drivers, and payer coverage considerations that affect national practice. Where input data is incomplete, the report flags "Data not available in the input." The goal is to provide clinicians, coders, and policy analysts a focused reference on CPT code 77435 to support accurate service classification and administrative workflows.
Billing Code Overview
CPT code 77435 describes management of a complete course of stereotactic body radiotherapy (SBRT) treatment using a three-dimensional coordinate system to locate small targets or lesions in the body, excluding the brain and spinal cord. The procedure delivers highly precise, externally generated ionizing radiation to destroy one or more lesions with an entire course that does not exceed five fractions.
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Service type: Stereotactic body radiotherapy (SBRT) treatment management
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Typical site of service: Outpatient radiation oncology clinic or hospital-based radiation therapy department
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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the physician interpretation/planning professional component separate from technical delivery. |