CurrentUnitedHealthcarePolicy 2026T0613L

Fractionation, Image-Guidance, and Special Services

Defines medical necessity criteria for external beam radiation therapy (EBRT) fractionation limits, indications for image-guided radiation therapy (IGRT), special services (dosimetry, physics consults, special procedures), and coding/billing clarifications for UnitedHealthcare Commercial and Individual Exchange plans. This part covers criteria for bone metastases, breast cancer, locally advanced NSCLC, and prostate cancer as well as coding guidance and supporting evidence summaries.

Policy Summary

PayerUnitedHealthcare

PolicyFractionation, Image-Guidance, and Special Services

Policy CodePolicy 2026T0613L

Change TypeCoding and coverage clarifications

Effective DateMar 1, 2026

Next Review Date

Key ActionFollow guideline-supported fractionation regimens and document rationale, including justification when reporting Level 3 delivery (CPT 77412) and imaging frequency/IGRT use per coding clarifications.

SourceLink

POLICY UPDATE CHANGES

Added criterion requiring delivery of up to 10 fractions for accelerated partial-breast irradiation with 3D technique.

Replaced connective tissue disorder wording to specify 'systemic lupus erythematosus or scleroderma' for delivery of up to 33 fractions (inclusive of boost).

Added instruction to refer to coding clarifications in the Applicable Codes section for IGRT.

Removed language indicating IGRT is not medically necessary for superficial treatment of skin cancer when listed criteria are not met.

Coding clarifications specifying which CPT codes correspond to levels of treatment complexity and inclusion of IGRT technical component in delivery codes.

Updated notation on megavoltage planning/imaging/treatment codes (77436-77439) usage for superficial, surface, or orthovoltage radiation therapy.

Updated notation that special dosimetry (CPT code 77331) should be used to document the me... (text truncated).

Defines Level 1/2/3 mapping and documentation requirement for Level 3; material for billing practice.

Clarified that the technical component of IGRT is included in CPT codes 77402, 77407, and 77412 and should not be reported separately; professional IGRT should be reported as 77387-26.

Updated notation that megavoltage planning, imaging, and treatment codes should not be reported during superficial, surface, or orthovoltage radiation therapy and that CPT codes 77436–77439 should be reported for those therapies.

Updated guidance that special dosimetry (77331) documents dose measurements at specific points with specialized devices and typically ranges from one to six measurements; IMRT planning (77301) includes special dosimetry.

Removed notation indicating CPT code 77301 is considered for coverage only when the primary radiation procedure is proven and medically necessary.

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4Major clinical indications with explicit fraction limits (bone mets, breast, NSCLC, prostate)

10+Key CPT codes referenced

3Revised Coding Clarifications

2Fractionation Criteria Added/Changed

multipleRandomized trials summarized

Coverage Summary

This policy covers external beam radiation therapy (EBRT) fractionation limits, image-guided radiation therapy (IGRT) indications, and special services (dosimetry, physics consultations, special procedures) for UnitedHealthcare Commercial and Individual Exchange plans. Coverage stance is mixed: specific indications are covered with explicit fraction limits while other uses require documentation or are not medically necessary. Major covered fractionation limits include: for palliative bone metastases, delivery of up to 10 fractions (greater than 10 fractions only when retreating a previously irradiated site); for accelerated partial-breast irradiation (APBI) with IMRT, delivery of up to 5 fractions, and with 3D technique up to 10 fractions, with whole-breast regimens up to 21 fractions and, in defined situations, up to 33 fractions inclusive of boost (criteria listed); for locally advanced non-small cell lung cancer, delivery of up to 35 fractions; for prostate cancer, delivery of up to 20 fractions for definitive treatment with limited metastatic disease, up to 28 fractions for localized disease, and up to 45 fractions when specified high-risk or prior-treatment criteria are met. The policy defines EBRT and IGRT and notes hypofractionation, hyperfractionation, and accelerated fractionation approaches and when special services (eg, CPT 77331, 77370, 77470, 77399) may be considered with supporting documentation. Coding and IGRT clarifications are integral to application of these criteria (see Applicable Codes/Coding Clarifications).

Thresholds and key stats

Hypofractionation definitionfraction size between 240 cGy and 340 cGy (defines >200 cGy as hypofractionated)

Number of special dosimetry measurementsTypically 1 to 6 measurements

Effective dateMarch 1, 2026

Medical-Necessity Criteria

Bone Metastases - Palliative EBRT

When providing palliative external beam radiation therapy (EBRT) for the treatment of bone metastases, the following are medically necessary:

Delivery of up to 10 fractions of radiation therapy

Delivery of greater than 10 fractions for the treatment of a site that has previously received radiation therapy

Breast Adenocarcinoma - EBRT Fractionation

When providing EBRT for breast adenocarcinoma, the following are medically necessary:

Delivery of up to five fractions for accelerated partial-breast irradiation with intensity-modulated radiation therapy (APBI with IMRT)

Delivery of up to 10 fractions for accelerated partial-breast irradiation with 3D technique (APBI with 3D)

Applicable Codes and Coding Guidance

Radiation treatment delivery and IGRT CPT codes (guidance / included technical component)CPT

77402	Radiation treatment delivery, simple; per treatment session (Level 1) - conventional single electron field, multiple electron fields or 2D photons.
77407	Radiation treatment delivery, intermediate; per treatment session (Level 2) - standard single-isocenter 3D or IMRT/VMAT treatments.
77412	Radiation treatment delivery, complex; per treatment session (Level 3) - multiple isocenters with photon therapy, single-isocenter with active motion management, total-skin electrons, or mixed electron/photon fields. Documentation required to justify Level 3 vs Level 2.
77387	Radiation treatment delivery, image guidance (IGRT) professional component (report with -26 when applicable).

Special dosimetry, physics, special procedures, unlisted codesCPT

77331	Special dosimetry — measurement of dose at a specific point using specialized devices; typically 1–6 measurements; IMRT planning (77301) includes special dosimetry.
77370	Special medical radiation physics consultation — used once for complex physics situations (e.g., complex photon/electron interrelationships, brachytherapy, SRS/SBRT, dose to fetus calculations, QMP fusion of multi-modality images in non-IMRT plans).
77470	Special treatment procedure — reported once for unusual circumstances (e.g., pediatric daily anesthesia, total body irradiation, very difficult setup, combination external beam and brachytherapy, concurrent cytotoxic therapy, hyperthermia). Not routine for contouring or routine SBRT/SRS without documentation of extra time/effort.
77399	Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services — use only if no other code appropriately describes the procedure or service.

Proton treatment delivery codesCPT

77520

Proton beam therapy delivery codes (example group) - report per appropriate proton delivery CPT where applicable (refer to payer-specific billing guidance).

Delivery Level Reporting Codes (examples and usage guidance)CPTCovered

77402	Level 1 reporting for simple treatment delivery.
77407	Level 2 reporting for standard single-isocenter 3D or IMRT/VMAT.
77412	Level 3 reporting for complex delivery; documentation required to support Level 3 selection over Level 2.

Megavoltage planning/imaging/treatment codes for superficial/orthovoltage therapyCPT

77436	Superficial radiation treatment delivery, per treatment session.
77437	Superficial radiation, complex treatment delivery/imaging/planning codes.
77438	Superficial radiation, planning/technical codes.
77439	Superficial radiation, special reporting where applicable.

Special dosimetry and IMRT planningCPTCovered

77331	Special dosimetry — typically 1–6 measurements; document measurement counts and justification for >6.
77301	IMRT planning — includes special dosimetry (do not separately report 77331 when planning includes it as part of 77301).

Callouts below summarize required provider actions and documentation expectations for reporting delivery levels, IGRT components, special dosimetry and special procedures, superficial/orthovoltage therapy coding, fractionation and technique selection, and image guidance frequency.

Note

Actionable Guidance Summary

Radiation treatment delivery reporting rules: report treatment delivery using the appropriate level of complexity. Use 77402 for conventional 2D/standard electron-only techniques (Level 1). Use 77407 for standard single-isocenter 3D conformal, IMRT, or VMAT treatments (Level 2). Use 77412 only when delivery meets Level 3 criteria (multiple isocenters for photon therapy; single-isocenter with active motion-management techniques; total-skin electrons; mixed electron/photon fields). When 77412 is used, documentation must clearly describe circumstances that justify Level 3 rather than Level 2.

IGRT and imaging reporting: when IGRT is used with 2D, 3D, IMRT, or VMAT techniques, the technical component of image guidance is included in the delivery codes 77402, 77407, and 77412 and must not be reported separately. The professional component of IGRT may be reported using 77387-26 when the professional interpretation/service is performed. IGRT is not separately reportable with SBRT or SRS. IGRT codes are not appropriate for imaging performed during brachytherapy; applicator verification should be coded as simple simulation (77280).

Megavoltage vs superficial/orthovoltage therapy: regardless of how many treatment sites are involved, megavoltage planning, imaging, and treatment delivery codes should NOT be reported during superficial, surface, or orthovoltage radiation therapy. For superficial/surface/orthovoltage therapy, report CPT codes 77436, 77437, 77438, or 77439 as appropriate. Ensure documentation supports the modality selection and that megavoltage services are not being double-reported.

Provider Actions and Billing Rules

High-priority billing rules (callouts)

Documentation & policy callouts

Background and Evidence Summaries

Radiation therapy comprises consultation, treatment planning, technical preparation (including simulation and dosimetry), treatment delivery, management, and follow-up. Fractionation approaches include: hypofractionation (larger dose per fraction delivered over fewer fractions; policy defines hypofractionation as fraction size between 240 cGy and 340 cGy), hyperfractionation (smaller-than-usual doses given more than once daily), and accelerated fractionation (moderate to large doses given twice daily to shorten overall treatment time). External beam radiation therapy (EBRT) encompasses 3D conformal RT, IMRT, and proton beam RT where high-energy rays or particles are aimed from outside the body. Image‑guided radiation therapy (IGRT) uses imaging during treatment delivery to localize and reposition the patient or delivery system to improve target localization and spare normal tissues; IGRT is indicated in numerous settings (eg, use with IMRT, proton therapy, prior-irradiated targets, implanted fiducials, or when motion management or tight margins are required) and may reduce margins and toxicity when appropriately applied. Special services (eg, special dosimetry CPT 77331, special physics consultation 77370, special treatment procedure 77470, and unlisted code 77399) are intended to document additional technical or physician effort for complex circumstances and require documentation that the primary radiation procedure is proven and medically necessary and that the special service is clinically justified.

Evidence summaries and comparative findings

Findings from randomized trials and meta-analyses summarized by disease site and treatment comparison:

Breast evidence: APBI randomized trials (Vicini/NSABP B-39/RTOG 0413; Meattini Florence trial; Whelan RAPID) and HF-WBI trials (START trials, FAST-Forward, Shaitelman) show varied results for IBTR, toxicity, and cosmesis; guideline recommendations (ASTRO, NCCN, NICE) support specific hypofractionation and APBI regimens

Definitions

Term	Definition
Level 1/2/3 treatment delivery	Level mapping: 77402 = Level 1 (conventional single electron field, multiple electron fields, or 2D photons); 77407 = Level 2 (standard single-isocenter 3D or IMRT/VMAT); 77412 = Level 3 (multiple isocenters with photon therapy, single-isocenter with active motion-management, total-skin electrons, or mixed electron/photon fields). When 77412 is reported, documentation must clearly describe circumstances that justify Level 3 rather than Level 2.
IGRT	Image-guided radiation therapy — imaging used during treatment delivery to localize and reposition the patient or delivery system prior to treatment to improve target localization and spare normal tissues. The technical component of IGRT is included in delivery CPT codes (77402, 77407, 77412) and should not be reported separately; the professional component may be reported as 77387-26. IGRT is medically necessary in specified circumstances (e.g., with IMRT, PBRT, prior radiation, implanted fiducials, certain 3D-CRT definitive treatments) and not medically necessary for aligning bony landmarks without fiducials.
APBI/PBI	Accelerated/Partial-Breast Irradiation (APBI/PBI) — radiotherapy directed to the lumpectomy bed rather than whole breast, using brachytherapy or external beam techniques. Policy specifies delivery limits: up to 5 fractions with IMRT, up to 10 fractions with 3D technique, and guideline-preferred dosing options (e.g., 30 Gy in 5 fractions or 3,000 cGy in 5 once-daily fractions).
HF-WBI	Hypofractionated whole-breast irradiation — larger dose per fraction delivered over fewer fractions (e.g., 40 Gy in 15 fractions or 42.5 Gy in 16 fractions). Hypofractionation defined as fraction size between 240 cGy and 340 cGy.
Limited Metastatic Disease	Limited Metastatic Disease (prostate only) — absence of visceral metastasis or fewer than four bone metastases, with no metastasis outside the vertebral bodies or pelvis. For Definitive Treatment in limited metastatic disease, delivery of up to 20 fractions is medically necessary.
Special dosimetry (CPT 77331)	Measurement of radiation dose at a specific point within a treatment area using specialized devices (e.g., thermoluminescent dosimeters, optically stimulated dosimeters, diode probes, film, implanted markers). CPT 77331 is used when measurements fall outside standard planning system parameters or equipment calibration; number of measurements typically ranges from one to six and requests beyond this range require documentation.
Definitive Treatment	Radiation treatments for cancer with a curative intent. Policy notes when used in contexts such as definitive EBRT for locally advanced NSCLC or prostate cancer fractionation schemes.

Revision History

revised

Added criterion requiring delivery of up to 10 fractions for accelerated partial-breast irradiation with 3D technique.

revised

Replaced connective tissue disorder wording to specify 'systemic lupus erythematosus or scleroderma' for delivery of up to 33 fractions (inclusive of boost).

added

Added instruction to refer to the coding clarifications in the Applicable Codes section for IGRT.

Policy Summary

PayerUnitedHealthcare

PolicyFractionation, Image-Guidance, and Special Services

Policy CodePolicy 2026T0613L

Change TypeCoding and coverage clarifications

Effective DateMar 1, 2026

Next Review Date

SourceLink

On This Page

Delivery of up to 21 fractions (inclusive of a boost to the tumor bed)

Delivery of up to 33 fractions (inclusive of a boost to the tumor bed) when ANY of the following criteria are met:

Treatment of supraclavicular and/or internal mammary lymph nodes

Postmastectomy radiation therapy

Individual has received previous thoracic radiation therapy

Individual has a connective tissue disorder such as systemic lupus erythematosus or scleroderma

When providing EBRT for breast cancer, delivery of greater than 33 fractions (inclusive of a boost to the tumor bed) is not medically necessary.

Locally Advanced Non-Small Cell Lung Cancer - EBRT Fractionation

When providing EBRT, with or without chemotherapy, for locally advanced non-small cell lung cancer, the following is medically necessary:

Delivery of up to 35 fractions

When providing EBRT, with or without chemotherapy, for locally advanced non-small cell lung cancer, delivery of greater than 35 fractions is not medically necessary.

Prostate Adenocarcinoma - EBRT Fractionation and Indications

When providing EBRT for prostate adenocarcinoma, the following are medically necessary:

Delivery of up to 20 fractions for Definitive Treatment in an individual with Limited Metastatic Disease

Delivery of up to 28 fractions for localized prostate cancer

Delivery of up to 45 fractions for localized prostate cancer when ANY of the following criteria are met:

ONE of:

Individual with high-risk prostate cancer is undergoing radiation treatment to pelvic lymph nodes

Radiation therapy is delivered post prostatectomy

Individual has a history of inflammatory bowel disease such as ulcerative colitis or Crohn disease

Individual has received previous pelvic radiation therapy

When providing EBRT for localized prostate cancer, delivery of greater than 45 fractions is not medically necessary.

Image-Guided Radiation Therapy (IGRT) - Medical Necessity

Image guidance for radiation therapy is medically necessary under any of the following circumstances:

When used with intensity-modulated radiation therapy (IMRT; e.g., prostate cancer)

When used with proton beam radiation therapy (PBRT)

When the target has received prior radiation therapy or abuts a previously irradiated area

When implanted fiducial markers are being used for target localization

During Definitive Treatment, using 3D conformal radiation therapy (3D-CRT) for the following conditions:

Breast cancer when any of the following apply:

Accelerated partial-breast irradiation

Breast boost with the use of photons

Hypofractionated radiation therapy delivered up to five fractions to the whole breast or chest wall

Individual is being treated in the prone position

Left breast cancer and deep inspiration breath-hold technique is being used

During boost treatment of rectal and bladder cancer

Esophageal cancer

Gastric cancer

Head and neck cancer

Hepatobiliary cancer

Lung cancer

Pancreatic cancer

Soft tissue sarcoma

IGRT when used with 3D-CRT may be medically necessary for a condition that is not listed above when documentation is provided, showing ONE or more of the following:

Clinically significant difference in normal tissue sparing between deep inspiration breath-hold and free breathing, as documented by comparison plans and dose-volume histogram (DVH)

Member unable to tolerate immobilization during computed tomography (CT) simulation

Significant target motion, as documented by imaging

Smaller clinical target volume (CTV) margins are required than what is traditionally used for 3D-CRT

When the above criteria are not met, IGRT is not medically necessary, including but not limited to the following circumstance:

To align bony landmarks without implanted fiducials (i.e., during palliative radiation therapy)

Note: Refer to the Coding Clarification section for special services and the use of IGRT with brachytherapy, stereotactic radiosurgery, and stereotactic body radiation therapy.

Special Services - Conditions for CPT 77331, 77370, 77470, 77399

Special services (CPT 77331, 77370, 77470, 77399) are subject to the following medical-necessity and usage conditions:

CPT 77331 – Special dosimetry: used to document measurement of radiation dose at a specific point within a treatment area using specialized devices (eg, thermoluminescent dosimeters, diode probes, film dosimetry, implanted markers). Use when measurements are needed outside standard planning system parameters or equipment calibration. Typical number of measurements: 1–6; requests beyond this range require supporting documentation. IMRT planning (CPT 77301) includes special dosimetry.

CPT 77370 – Special medical radiation physics consultation: report once for circumstances such as complex photon/electron interrelationships; brachytherapy; SRS or SBRT; analysis of customized beam modification devices; computing dose to the fetus; specialized brachytherapy equipment; developed by a qualified medical physicist to treat a specific individual; radioisotope treatment; individuals with implanted cardiac devices; fusion of 3D image sets from multiple modalities in non-IMRT plans.

CPT 77470 – Special treatment procedure: report once for circumstances such as pediatric individuals requiring daily anesthesia; total body or hemibody irradiation; per oral or endocavitary irradiation; individuals very difficult to set up; combination external beam and brachytherapy; concurrent cytotoxic chemotherapy and/or targeted therapy; radioimmunotherapy combined with external beam; hyperthermia; yttrium microsphere radiotherapy. Routine use for contouring in 3D-CRT or IMRT, or routine use for SBRT/SRS without extra time/effort documentation, is inappropriate. There is no situation in which 77470 may be routinely used.

CPT 77399 – Unlisted procedure: report only if no other code appropriately describes the procedure or service.

Usage note: When special services/IGRT are used with brachytherapy, SRS, or SBRT, refer to coding clarification guidance. Documentation supporting the medical necessity, complexity, and time/effort is required for payment consideration.

Special dosimetry and IMRT planning: CPT 77331 documents point-dose measurements using specialized dosimeters when doses fall outside standard planning system parameters or calibration. Typical measurement counts range from 1 to 6; document measurement count and rationale. IMRT planning (CPT 77301) includes special dosimetry, so 77331 should not be reported separately when 77301 fully describes the planning services provided. CPT 77370 may be reported once for specialized medical physics consultation when criteria are met.

Radiation Treatment Delivery Reporting Rules

Operational decision tree: Radiation Treatment Delivery Reporting Rules — documents when specific delivery codes apply and what must be present in the medical record.

ALL of the following

Select the delivery level code that matches the technical complexity of the treatment session: 77402 (Level 1), 77407 (Level 2), or 77412 (Level 3).
If selecting 77412 (Level 3), include documentation describing the specific reasons for Level 3 classification (e.g., multiple isocenters, active motion management, total-skin electrons, mixed electron/photon fields).
Operational requirement: documentation must clearly justify Level 3 vs Level 2.
When IGRT is used with 2D/3D/IMRT/VMAT, do not separately bill the IGRT technical component; it is included in 77402/77407/77412.
If professional IGRT services are provided, report as 77387-26 when appropriate.

Megavoltage Planning/Imaging/Treatment and Superficial Therapy Reporting

Operational decision tree: Megavoltage planning/imaging/treatment and Superficial Therapy Reporting — guidance to prevent miscoding between megavoltage and superficial modalities.

ALL of the following

Determine the modality used: megavoltage versus superficial/surface/orthovoltage.
If superficial/surface/orthovoltage therapy was delivered, do NOT report megavoltage planning, imaging, or treatment delivery codes; report CPT 77436–77439 as applicable.
If megavoltage therapy was delivered, report appropriate megavoltage planning and delivery codes (e.g., 77402/77407/77412) and include IGRT technical component in delivery codes when used.

Special Dosimetry (CPT 77331) Usage

Special dosimetry reporting: conditions and typical measurement counts.

ALL of the following

Use CPT 77331 to document special point-dose measurements when doses fall outside standard planning system parameters or equipment calibration.
Document the measurement method and devices used (e.g., thermoluminescent dosimeters, diode probes, film dosimetry, implanted markers).
Record the number of measurements; typical counts range from 1 to 6. Any request for >6 measurements must include supporting documentation and will be reviewed on a case-by-case basis.
Do not report 77331 separately when IMRT planning (CPT 77301) is billed and includes special dosimetry as part of the plan.

Includes randomized trial outcomes and guideline recommendations

NSCLC evidence: RTOG 0617 (Bradley) showed higher dose (74 Gy) worse OS vs standard (60 Gy); ASCO/NCCN recommend concurrent chemoradiation ~60 Gy for unresectable stage III and IGRT as appropriate

Prostate evidence: Randomized trials and meta-analyses (Murthy POP-RT, CHHiP, HYPRO, Cochrane reviews) support moderate hypofractionation (eg, 60 Gy/20 fx) as noninferior for localized disease; WPRT may improve biochemical outcomes in high-risk patients

IGRT evidence: Systematic reviews and cohort studies (Wang 2022, Kilburn 2016, others) demonstrate IGRT reduces acute GU/GI toxicity and may improve local control and biochemical outcomes in prostate and lung cancers

Key evidence — trials and guidelines

AHRQ (Skelly et al., 2023)Found similar overall pain response for single- vs multiple-fraction EBRT; reirradiation more common after single-fraction

ASTRO PBI & WBI (Shaitelman et al./ASTRO 2024)APBI recommendations and HF-WBI preferred regimens; external beam PBI 3000 cGy/5 fx or 4005 cGy/15 fx

NSABP B-39/RTOG 0413 (Vicini et al., 2019)APBI (brachy 34 Gy or EBRT 38.5 Gy/10 fx) vs WBI: IBTR 4.6% vs 3.9% at ~10.2 yrs; APBI did not meet equivalence

Whelan et al. (2019)External-beam APBI 38.5 Gy/10 fx twice-daily vs WBI: 8-yr IBTR 3.0% vs 2.8%; lower acute toxicity but higher late toxicity/cosmesis with APBI

RTOG/NRG (Bradley et al., 2015)High-dose (74 Gy) with concurrent chemo worse OS and increased severe esophagitis vs standard-dose (60 Gy)

Murthy et al. (2021)Whole pelvic RT improved 5-yr BFFS vs prostate-only RT (95.0% vs 81.2%) in high-risk prostate cancer

Wang et al. (2022) meta-analysis (IGRT)IGRT reduced acute GU and GI toxicity and improved 3-year PSA relapse-free survival with daily IGRT

removed

Removed language indicating IGRT is not medically necessary for superficial treatment of skin cancer when listed criteria are not met.

clarified

Coding clarifications specifying which CPT codes correspond to levels of treatment complexity and inclusion of IGRT technical component in delivery codes (specified 77402 Level 1, 77407 Level 2, 77412 Level 3; professional IGRT reported as 77387-26).

revised

Updated notation on megavoltage planning/imaging/treatment codes (77436-77439) usage for superficial, surface, or orthovoltage radiation therapy.

revised

Updated notation that special dosimetry (CPT code 77331) should be used to document dose measurements at specific points with specialized devices and typically ranges from one to six measurements; IMRT planning (77301) includes special dosimetry.

revised

Updated notation that special dosimetry (CPT code 77331) should be used to document the measurement of radiation dose at a specific point within a treatment area using specialized devices; number of measurements typically ranges from one to six and requests beyond this range must be documented.

clarified

Defines Level 1/2/3 mapping and documentation requirement for Level 3; material for billing practice (when 77412 reported, documentation must justify Level 3).

clarified

Clarified that the technical component of IGRT is included in CPT codes 77402, 77407, and 77412 and should not be reported separately; professional IGRT should be reported as 77387-26.

clarified

Updated guidance that special dosimetry (77331) documents dose measurements at specific points using specialized devices and typically ranges from one to six measurements; IMRT planning (77301) includes special dosimetry.

removed

Removed notation indicating CPT code 77301 is considered for coverage only when the primary radiation procedure is proven and medically necessary.

2026-03-01material_changeLatest

Effective date: March 1, 2026 — implemented material revisions including APBI 3D up to 10 fractions, specified connective tissue disorders (systemic lupus erythematosus or scleroderma) for up to 33 fractions, IGRT coding clarifications, and updates to dosimetry and megavoltage code guidance.