Summary & Overview
CPT 77438: Orthovoltage Surface Radiation Therapy, Single Fraction
CPT code 77438 designates a single-fraction surface radiation therapy (SRT) treatment delivered with orthovoltage X rays in the >150–500 kV range for skin cancers and other superficial lesions requiring penetration up to approximately 4 cm. Nationally, this code is relevant to oncology practices, dermatology clinics offering radiation therapy, and payers managing coverage for non-invasive treatment options that can avoid more extensive surgical procedures.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context and service setting, typical payer coverage considerations, and benchmarking topics such as utilization patterns and reimbursement parameters where available. The publication summarizes how CPT code 77438 fits within the SRT and superficial radiation therapy service line and highlights common operational and billing touchpoints for one-fraction orthovoltage treatment.
Content covers clinical description, typical sites of service, common documentation elements needed to support medical necessity, and how this code is used in practice. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 77438 describes a single-fraction delivery of surface radiation therapy (SRT) using orthovoltage X rays in the >150 to 500 kilovoltage (kV) range. This technique is intended for treatment of skin cancers and other superficial lesions that require somewhat deeper penetration than very superficial modalities; orthovoltage beams can penetrate up to about 4 cm from the skin surface.
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Service type: Surface radiation therapy using orthovoltage X-ray beam for one treatment session (per fraction).
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Typical site of service: Outpatient radiation oncology clinic or hospital outpatient department providing superficial/orthovoltage radiation treatments.
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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.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the day of a procedure | Use when a medically necessary E/M visit is performed and documented on the same day as distinct from the radiation treatment planning or delivery |