2025 CPT code 77431
(Active) Effective Date: N/A Revision Date: N/A Radiology - Radiation Treatment Management Radiology Procedures > Radiation Oncology Treatment Feed
Radiation therapy management for a complete course of therapy consisting of one or two fractions.
Modifiers may apply depending on the circumstances of service. Consult the CPT manual and payer-specific guidelines for appropriate modifier usage.
Medical necessity for radiation therapy is established based on the diagnosis, tumor characteristics, patient's general health, and the potential benefits compared to the risks. Documentation supporting the need for the specific number of fractions and the overall treatment plan is essential.
The radiation oncologist is responsible for all aspects of treatment planning and delivery, patient assessment, and management of any complications arising from the radiation therapy. This includes, but is not limited to:initial consultation, treatment plan development, simulation, review of imaging, treatment delivery oversight, and post-treatment follow-up.
In simple words: This code covers the doctor's work in managing your entire radiation therapy treatment, which involves just one or two small doses of radiation given over a period of weeks. This includes checking your progress, coordinating care, and reviewing test results.
This CPT code, 77431, represents the comprehensive management of radiation therapy, encompassing a complete treatment course limited to one or two fractions.The radiation oncologist's responsibilities include medical evaluation and management (e.g., assessing patient response, coordinating care, reviewing imaging and lab results), reviewing port films, dosimetry, dose delivery parameters, and treatment setup. This code does not cover extended courses of therapy; code 77427 is used for additional fractions beyond a multiple of five.
Example 1: A patient with early-stage breast cancer receives a single fraction of stereotactic radiosurgery (SRS) for a small tumor. Code 77431 would reflect the radiation oncologist's management of this single-fraction treatment., A patient with prostate cancer undergoes two fractions of external beam radiotherapy (EBRT) separated by a week.Code 77431 would capture the radiation oncologist's management of the entire treatment course., A patient with a small lung nodule receives two fractions of SBRT. Code 77431 would be used, along with 77387 for guidance in target volume localization.
Detailed medical history, including cancer diagnosis and staging; imaging studies (CT, MRI, PET); treatment plan documentation; port films; dosimetry reports; progress notes documenting patient response and any adverse effects; and any other relevant clinical information.
** This code should not be used to bill for the last week of a longer course of therapy. For additional fractions beyond a multiple of five, 77427 is used. Always ensure proper documentation to support the medical necessity and the number of fractions provided.
- Revenue Code: P7A (ONCOLOGY - RADIATION THERAPY)
- RVU: Information not available in provided sources.Consult the AMA CPT codebook or a relevant pricing database for RVU values and reimbursement details.
- Global Days: Not specified in the provided data.The global period would depend on payer-specific policies.
- Payment Status: Active
- Modifier TC rule: Not applicable for this code as it represents professional services.
- Fee Schedule: Information not provided. Consult a historical fee schedule database or relevant billing records.
- Specialties:Radiation Oncology
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center