Stereotactic Body Radiation Therapy (SBRT) Coverage Criteria
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This policy governs coverage and coding for Stereotactic Body Radiation Therapy (SBRT) for Medicare Advantage and Commercial members of Blue Cross Blue Shield - Rhode Island. It specifies covered CPT codes, fractions, and that prior authorization and medical criteria are not applicable.
Effective 10/1/2025, Stereotactic Body Radiation Therapy (SBRT) is covered for both Medicare Advantage Plans and Commercial Products.
Prior authorization is not required for the listed SBRT CPT codes.
SRS (intracranial stereotactic radiosurgery) remains a covered service but this policy applies to SBRT only.
Coverage Criteria
Coverage Conditions
Covered when the following administrative conditions are met
Coverage for Stereotactic Body Radiation Therapy (SBRT) may vary by group or contract. Refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for the applicable radiation therapy benefits, as those documents govern coverage determinations.
For member-specific benefit information, contact the provider call center. The policy provisions do not supersede the member's subscriber agreement or employer agreement when there is a conflict.
If services are determined to be not medically necessary or are non-covered benefits, the provider may not charge the member unless the member has been informed and has agreed in writing in advance to accept financial responsibility for the services.
This medical policy is informational and is not a guarantee of payment; benefits and eligibility are determined by the member's subscriber agreement, member certificate, or employer agreement, which will supersede the policy.
Coding and Fractions
| 77435 | Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions |
| 32701 | Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment |
| 77373 | Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions |
| 77435 | Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions |
Provider Actions and Billing Rules
Prior Authorization Not Required for Listed SBRT Codes
The CPT codes listed for stereotactic body radiation therapy (SBRT) below are covered for Medicare Advantage and Commercial products. Prior authorization is not required for these codes.
- 77435 — Stereotactic body radiation therapy, treatment management, per treatment course, to one or more lesions, including image guidance, entire course not to exceed 5 fractions
- 77373 — Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
- 32701 — Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), entire course of treatment
Benefits Verification
Verify member benefits, eligibility, and plan-specific coverage prior to scheduling and billing SBRT services. Coverage may vary by product and employer agreement; contact the provider call center for member-specific information.
Member Financial Liability Risk
If services are determined to be not medically necessary or are non-covered benefits under the member's plan, the member may be financially liable only if they were informed and provided written agreement in advance. Refer to the member's subscriber agreement, employer agreement, and your provider participation agreement for applicable provisions.
Provider Actions / Additional Notes
For general policy information and questions, use the provider call center or submit comments via the policy feedback mechanism.
Background
Stereotactic body radiotherapy (SBRT) delivers highly focused, convergent radiotherapy beams to a precisely defined three‑dimensional target using imaging guidance. This approach concentrates dose to the lesion while sparing adjacent radiosensitive structures.
Stereotactic radiosurgery (SRS) refers primarily to intracranial stereotactic radiotherapy, whereas SBRT is applied to intracranial and extracranial sites. This policy addresses coverage and coding for SBRT specifically.
Definitions
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