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Radiation therapy management involves the oversight and administration of radiation treatment to patients undergoing therapy for various medical conditions. Specifically, CPT® Code 77431 refers to the management of a complete course of radiation therapy that consists of only 1 or 2 fractions. This abbreviated treatment regimen is particularly relevant for certain conditions that may respond effectively to a limited number of radiation doses. Examples of such conditions include keloids, which are raised scars that can be treated with radiation to reduce their size; heterotopic ossifications, which are abnormal bone growths that can occur in soft tissues; and potential bone metastasis, where cancer has spread to the bones. The process of radiation therapy management encompasses several critical components, including the review of imaging studies such as port films, which help in assessing the treatment area, and a thorough chart review to ensure accurate dosimetry and dose delivery. Additionally, the treatment management includes evaluating the patient's treatment setup and conducting a physical examination or face-to-face encounter to monitor the patient's progress, side effects, and overall response to the radiation therapy. The findings from these evaluations are documented by the radiation oncologist or another qualified medical professional, who will then make informed recommendations regarding the continuation or conclusion of the radiation treatment based on the patient's condition and response.
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Radiation therapy management with CPT® Code 77431 is indicated for specific medical conditions that may benefit from a short course of radiation treatment consisting of 1 or 2 fractions. The following conditions are explicitly recognized as suitable for this type of therapy:
The procedure for radiation therapy management under CPT® Code 77431 involves several key steps that ensure the effective delivery of treatment. Each step is crucial for achieving the desired therapeutic outcomes while monitoring patient safety and response.
Post-procedure care following radiation therapy management with CPT® Code 77431 involves monitoring the patient for any immediate side effects or complications that may arise from the treatment. Patients are typically advised to report any unusual symptoms or changes in their condition. Follow-up appointments may be scheduled to assess the effectiveness of the treatment and to evaluate the patient's recovery. The healthcare team will continue to provide support and guidance, ensuring that the patient receives comprehensive care throughout their treatment journey.
| Short Descr | RADIATION THERAPY MANAGEMENT | Medium Descr | RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY | Long Descr | Radiation therapy management with complete course of therapy consisting of 1 or 2 fractions only | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 2 - Professional Component Only Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Code Not Recognized by OPPS when submitted on Outpatient Hospital Part B Bill Type (12x/13x) | Type of Service (TOS) | 6 - Therapeutic Radiology | Berenson-Eggers TOS (BETOS) | P7A - Oncology - radiation therapy | MUE | 1 | CCS Clinical Classification | 211 - Therapeutic radiology |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2009-01-01 | Changed | Code description changed |
| 1991-01-01 | Added | First appearance in code book in 1991. |
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