HCPCS C9795: Stereotactic Body Radiation Therapy Delivery with PET-Based Adjustments - OpenPayer

Summary & Overview

HCPCS C9795: Stereotactic Body Radiation Therapy Delivery with PET-Based Adjustments

HCPCS Level II code C9795 represents stereotactic body radiation therapy (SBRT) treatment delivery, billed per fraction for one or more lesions, and includes image guidance with real-time positron emissions-based delivery adjustments. It is limited to an entire course not to exceed five fractions. This code captures advanced radiation-delivery techniques that integrate imaging and PET-based real-time targeting adjustments, reflecting a growing emphasis on precision dose delivery in radiation oncology.

Key payers in this national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage considerations and payer approaches, along with clinical context for when the code is used. The publication summarizes benchmarks for utilization and reimbursement where available, highlights recent policy updates affecting SBRT delivery codes, and outlines operational details relevant to billing and documentation.

The content provides clinical context for SBRT delivery per fraction, outlines typical sites of service, and identifies common billing modifiers and related administrative considerations. Data not available in the input is noted where applicable. This summary is intended for health policy analysts, revenue cycle professionals, and clinical leaders seeking a national-level briefing on the role and billing characteristics of C9795 in modern radiation oncology practice.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareC9795HCPCS Level IISBRTradiation-therapystereotactic-body-radiation-therapyimage-guided-radiation-therapypositional-emission-guidanceoncology-billing

Billing Code Overview

HCPCS Level II code C9795 describes stereotactic body radiation therapy (SBRT) treatment delivery billed per fraction for one or more lesions. The code includes image guidance and real-time positron emissions-based delivery adjustments to one or more lesions and is limited to an entire course not to exceed five fractions.

Service type: Radiation therapy — stereotactic body radiation therapy (SBRT) delivery, per fraction.

Typical site of service: Hospital outpatient department or free-standing radiation oncology center.

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with a history of metastatic non-small cell lung cancer is referred for stereotactic body radiation therapy (SBRT) to a 2.5 cm peripheral lung lesion identified on recent CT and PET imaging. The multidisciplinary tumor board determined the lesion is appropriate for SBRT due to limited disease burden and prior intolerance to systemic therapy. The radiation oncology workflow includes evaluation and simulation with immobilization, CT simulation with 4D motion assessment, fusion of diagnostic PET/CT for target delineation, treatment planning with high-dose per fraction conformal beams or volumetric-modulated arc therapy, and image-guided delivery.

On each treatment day, pre-treatment image guidance (cone-beam CT or fan-beam CT) is obtained and compared to planning images. Real-time positron emissions-based delivery adjustments are available and used when PET-guided tracking detects intrafraction target motion or metabolic shifts, with automatic gating or couch/shifting as needed. This HCPCS Level II code C9795 represents the per-fraction delivery of SBRT with image guidance and real-time PET-based delivery adjustments for up to five fractions. Typical staff involved include a radiation oncologist, medical physicist, dosimetrist, radiation therapists, and nursing. Typical sites of service are hospital outpatient departments, freestanding radiation oncology centers, and tertiary care cancer centers. Typical clinical scenarios include primary early-stage lung tumors, isolated liver metastases, spinal oligometastases, or other limited-volume metastatic lesions where highly conformal, image-guided, high-dose-per-fraction radiotherapy is indicated.

Coding Specifications

Modifier	Description	When to Use

HCPCS C1779: Pacemaker Lead, Transvenous VDD Single Pass

HCPCS-C2616-YTTRIUM-90-BRACHYTHERAPY-SOURCE-NON-STRANDED

HCPCS C2616: Yttrium-90 Brachytherapy Source, Non-Stranded

HCPCS-C9486-GRANISETRON-EXTENDED-RELEASE-INJECTION-0-1-MG

HCPCS C9486: Granisetron Extended-Release Injection, 0.1 mg

HCPCS-C7539-PACEMAKER-IMPLANTATION-WITH-LV-LEAD-DURING-GENERATOR-INSERTION

HCPCS C7539: Pacemaker Implantation with Left Ventricular Lead During Generator Insertion

HCPCS-C9817-CRYO-PNEUMATIC-PAIN-MANAGEMENT-SYSTEM-POST-SURGICAL

HCPCS C9817: Electronic Cryo-Pneumatic Compression Pain Management System

HCPCS-C7541-DIAGNOSTIC-ERCP-BRUSHING-WASHING

HCPCS C7541: Diagnostic ERCP with Brushing/Washing and Duct Visualization

HCPCS-C9796-ENTEROCUTANEOUS-FISTULA-PLUG-REPAIR-SMALL-INTESTINE-COLON

HCPCS C9796: Repair of Enterocutaneous Fistula with Plug

HCPCS-C8901-MRA-ABDOMEN-WITHOUT-CONTRAST

HCPCS C8901: Magnetic Resonance Angiography Without Contrast, Abdomen

HCPCS-C9755-PERCUTANEOUS-MAGNETIC-GUIDED-AV-FISTULA-CREATION-RF

HCPCS C9755: Percutaneous Magnetic-Guided Arteriovenous Fistula Creation

HCPCS-C1726-NON-VASCULAR-BALLOON-DILATATION-CATHETER

HCPCS C1726: Catheter, Balloon Dilatation, Non-Vascular

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`22`	Increased Procedural Services	Use when the SBRT delivery requires substantially greater resources or complexity than typical (e.g., extensive adaptive maneuvers, prolonged immobilization) and documentation supports unusual effort.
`23`	Unusual Anesthesia	Use if general anesthesia or deep sedation is required for patient immobilization during simulation or a treatment fraction.
`52`	Reduced Services	Use when a fraction is partially reduced (e.g., abbreviated delivery due to early termination) and documentation supports reduced service.
`53`	Discontinued Procedure	Use when a treatment fraction is started but discontinued due to an emergent contraindication or patient instability.
`54`	Surgical Care Only	Not typically applicable to SBRT delivery; reserved for surgical episodes — included if part of concurrent surgical billing scenarios.
`55`	Postoperative Management Only	Not typically applicable; include only if postoperative radiation is separately billed in a different global period.
`56`	Preoperative Management Only	Rarely applicable; use only if preoperative radiation management is separately reported.
`62`	Two Surgeons	Rare for radiation delivery; use only when two qualified individuals share critical procedural duties and payer requires the modifier.
`AS`	Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Service	Use when an advanced practice clinician performs part of the professional service under state scope and payer allows billing.
`QK`	Medical Direction of Two, Three, or Four Technicians by a Physician	Use when the physician medically directs multiple radiation therapists during complex SBRT delivery per payer policy.
`QX`	Certified Registered Nurse Anesthetist (CRNA) Service with Medical Direction by a Physician	Use when CRNA provides anesthesia during simulation or treatment under physician direction.
`QY`	Medical Direction of One Certified Registered Nurse Anesthetist by an Anesthesiologist	Use when anesthesiologist medically directs CRNA for procedure-related anesthesia.
`CQ`	Service Delivery, Charge Captured by Ancillary Provider	Use when a contract or ancillary provider submits the charge for delivery components per payer arrangements.
`FX`	Primary Physician Modifiers for Anesthesia Assistants	Use only if anesthesia assistant services are involved in the treatment session.

Taxonomy Code	Specialty	Notes
`2084P0800X`	Radiation Oncology	Primary specialty that directs and oversees SBRT planning and delivery.
`173E00000X`	Medical Physics	Medical physicists perform dosimetry, quality assurance, and real-time delivery adjustments.
`225100000X`	Radiation Therapist	Radiation therapists operate treatment machines, perform image guidance, and implement delivery adjustments.
`363L00000X`	Nurse Practitioner	Advanced practice clinicians involved in patient management and on-treatment assessments.
`208000000X`	Radiation Oncology Assistant / Dosimetrist	Dosimetrists design the treatment plan and adaptive re-planning when needed.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Common primary lung cancer indication for SBRT to a peripheral lung lesion.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	SBRT is used for isolated liver metastases when focal high-dose therapy is indicated.
`C79.51`	Secondary malignant neoplasm of bone	Oligometastatic bone lesions, including spine, are common SBRT targets for pain control and local control.
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Selected recurrent or oligometastatic breast lesions may be treated with SBRT.
`C61`	Malignant neoplasm of prostate	SBRT is an accepted modality for definitive treatment of localized prostate cancer in select patients.
`M54.5`	Low back pain	Symptom code sometimes used in conjunction with spinal metastasis when treating painful vertebral lesions with SBRT.
`Z85.118`	Personal history of malignant neoplasm of bronchus and lung	Used in follow-up care contexts where SBRT is applied for recurrent or new lesions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`77295`	Three-dimensional radiotherapy plan, target volume(s), and treatment dose–volume histograms for stereotactic body radiation therapy (SBRT)	Used for complex SBRT treatment planning that supports per-fraction delivery billed under `C9795`.
`77373`	Stereotactic body radiation therapy, treatment delivery, per course of treatment to 1 site (single or multiple fractions)	Alternative/adjunct SBRT delivery code; payer policies may require `C9795` for PET-based real-time adjustments or `77373` for standard SBRT course reporting.
`77014`	Computed tomography guidance for stereotactic procedures (separate CT used during delivery)	Used when intra-procedural CT imaging guides set-up and verification before or during SBRT fractions.
`77290`	Therapeutic radiological treatment delivery, stereotactic radiosurgery (SRS), per fraction to cranial lesion(s)	Related stereotactic delivery code for cranial radiosurgery; included for clinical workflow comparison when cranial stereotactic techniques are employed.
`01996`	Anesthesia for intracranial or spinal neurosurgical procedures (when anesthesia is required for immobilization)	Used when general anesthesia or deep sedation is required for simulation or treatment fractions and is billed separately under appropriate anesthesia modifiers.

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