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    OpenPayerBilling CodesRadiation Treatment ManagementCPT cpt-77438-orthovoltage-surface-radiation-therapy-single-fraction
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    CPT 77438: Orthovoltage Surface Radiation Therapy, Single Fraction

    Medicare pays $116 on average nationally for this procedure.

    CPT code 77438 describes a single-fraction surface radiation therapy (SRT) session using orthovoltage X-rays (greater than 150 to 500 kV) for treatment of skin cancers or other lesions that require slightly deeper penetration (up to about 4 cm); service type: surface radiation therapy (orthovoltage SRT); typical site of service: outpatient radiation oncology clinic or hospital outpatient department.

    For related coverage guidance, see recent payer policy updates: Destruction of Pre-Malignant Skin Lesions, Onychomycosis diagnostic testing and coverage, Treatment of Capillary Malformations (Port Wine Stains).

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A 72-year-old patient presents to a radiation oncology clinic with a biopsy-proven squamous cell carcinoma of the nasal ala measuring 1.8 cm in greatest diameter and extending into the superficial subcutaneous tissues. Given tumor depth (involving dermis and superficial subcutis) and location where cosmesis and tissue preservation are priorities, the multidisciplinary team elects orthovoltage surface radiation therapy. On the day of treatment, the patient is evaluated by the radiation oncologist, treatment field and applicator size are documented, immobilization and shielding are applied as needed, and a single fraction of orthovoltage kilovoltage X-ray therapy is delivered using the orthovoltage unit. Nursing documents patient tolerance and skin care instructions. Typical site of service is an outpatient radiation oncology department or hospital-based radiation therapy suite. The procedure represented by 77438 is performed when lesions require slightly deeper penetration than superficial SRT (up to ~4 cm) and when external beam megavoltage therapy is not necessary or when orthovoltage provides optimal dose distribution for skin and superficial subcutaneous tumors.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    77300Special medical radiation physics consultation, for therapy service, including chart reviewPerformed prior to or during treatment planning when complex dosimetry or special considerations for orthovoltage are required
    77336Continuing medical physics consultation, technical direction and planning for radiation treatment deliveryUsed for ongoing physics oversight during a course of radiation therapy that may include orthovoltage fractions
    77427Radiation treatment management, 5 treatmentsUsed to report radiation treatment management for a portion of a course of therapy; orthovoltage fractions such as 77438 are part of the overall management series
    17000Destruction of premalignant lesions (e.g., topical procedures) ; first lesionMay be performed for superficial lesions in the same patient but is an alternative local therapy rather than combined with 77438
    11102Tangential biopsy of skin lesion including closure, when performed for diagnosisMay be performed prior to 77438 to obtain definitive histologic diagnosis supporting radiation therapy
    77499Unlisted radiation procedureUsed only when a specific orthovoltage-related service cannot be reported by an established code; not routine for standard 77438 delivery

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    27Modifier 27 indicates a separate, subsequent outpatient hospital E/M service provided to the same patient on the same date by a different provider in a hospital outpatient setting. It is a…- Use modifier -27 on facility (hospital outpatient/ambulatory service center) claims to report a subsequent, separate, and distinct outpatient E/M service provided to the same patient on the same…
    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…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207L00000X
    207P00000X
    363A00000X
    2472V0600X
    133VN1401X
    101YP2500X
    133NN1002X
    235Z00000X

    Related ICD-10-CM Codes

    21 rows

    ICD-10-CM CodeDescription
    C43.9Malignant melanoma of skin, unspecified
    C44.111Basal cell carcinoma of skin of unspecified eyelid, including canthus
    C44.121Squamous cell carcinoma of skin of unspecified eyelid, including canthus
    C44.131Sebaceous cell carcinoma of skin of unspecified eyelid, including canthus
    C44.209Unspecified malignant neoplasm of skin of left ear and external auricular canal
    C44.211Basal cell carcinoma of skin of unspecified ear and external auricular canal
    C44.311Basal cell carcinoma of skin of nose
    C44.511Basal cell carcinoma of skin of breast
    C44.521Squamous cell carcinoma of skin of breast
    C44.611Basal cell carcinoma of skin of unspecified upper limb, including shoulder

    Showing 1–10 of 21

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01
    Topical Acne-Non-Retinoid ProductsCigna2026-08-15
    Dermatology - Vtama Drug Quantity Management Policy - Per DaysCigna2026-08-15
    Medical Necessity Guidelines: Acne and Rosacea Medicationsharvard pilgrim health care2026-08-11
    Dermatology - Anzupgo Prior Authorization PolicyCigna2026-08-05
    Light Therapy for Dermatologic Conditionsbcbsvermont2026-08-01

    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-77435-STEREOTACTIC-BODY-RADIOTHERAPY-TREATMENT-MANAGEMENT

    CPT 77435: Stereotactic Body Radiotherapy Course (≤5 Fractions)

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

    CPT 77437: Superficial Radiation Therapy, Per 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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