Reimbursement & coding
A practical overview of the CPT codes used in radiation oncology — simulation, planning, conventional/IMRT/IGRT/SBRT delivery, brachytherapy, weekly management, and special procedures — plus the billing basics every radiation therapist should know.
CPT codes and Medicare fee schedules are revised regularly. The codes below reflect the January 1, 2026 changes: treatment delivery is now reported with three complexity-based codes (77402, 77407, 77412) that include imaging guidance, plus a single professional image-guidance code (77387); the former per-fraction delivery codes (77401, 77403, 77417, 77418), IMRT guidance-and-tracking codes (77385, 77386), 77014, and the delivery G-codes were deleted. New surface-therapy codes (77436–77439) also took effect for superficial and orthovoltage planning and delivery. Planning, management, SRS/SBRT, and brachytherapy codes were not substantially changed. Always confirm against the current AMA/CPT and CMS Physician Fee Schedule and your local payer policies before submitting claims.
| CPT code | Description | Typical use |
|---|---|---|
| 77280 | Simple simulationSingle treatment area, simple setup, no contrast — basic palliative or simple fields | Single treatment area, simple setup, no contrast — basic palliative or simple fields |
| 77285 | Intermediate simulationTwo separate treatment areas, three or more converging ports, or multiple blocks | Two separate treatment areas, three or more converging ports, or multiple blocks |
| 77290 | Complex simulationThree or more treatment areas, or particle/arc therapy, complex or custom blocking, brachytherapy simulation, or any use of contrast | Three or more treatment areas, or particle/arc therapy, complex or custom blocking, brachytherapy simulation, or any use of contrast |
| 77293 | Respiratory motion management simulation (add-on)Physician work for respiratory motion management during simulation | Physician work for respiratory motion management during simulation |
| 77014 (deleted Jan 2026) | CT guidance for RT fields — retiredFormerly CBCT/CT guidance at the treatment unit; now bundled into the 2026 delivery codes (77402/77407/77412) and professional code 77387 | Formerly CBCT/CT guidance at the treatment unit; now bundled into the 2026 delivery codes (77402/77407/77412) and professional code 77387 |
| 76377 | 3D image fusion / manipulationCo-registering diagnostic MRI, PET, or prior CT with the planning CT | Co-registering diagnostic MRI, PET, or prior CT with the planning CT |
| 77370 | Special physics consultPhysics review of complex simulation / dose distribution (once per course) | Physics review of complex simulation / dose distribution (once per course) |
| CPT code | Description | Typical use |
|---|---|---|
| 77300 | Basic radiation dosimetry calculationSingle isodose / point-dose or hand calculation (per beam or calculation) | Single isodose / point-dose or hand calculation (per beam or calculation) |
| 77261 – 77263 | Clinical treatment planningSimple (one port or opposed pair), intermediate (3+ converging ports or 2 areas), complex (3+ areas, tangents, special beams) | Simple (one port or opposed pair), intermediate (3+ converging ports or 2 areas), complex (3+ areas, tangents, special beams) |
| 77306 | Teletherapy isodose plan, simpleOne or two unmodified ports to a single treatment area; includes basic dosimetry | One or two unmodified ports to a single treatment area; includes basic dosimetry |
| 77307 | Teletherapy isodose plan, complexMultiple areas, tangential ports, wedges, blocking, rotational or special beam considerations | Multiple areas, tangential ports, wedges, blocking, rotational or special beam considerations |
| 77295 | 3D radiotherapy plan with DVHThree-dimensional conformal plan including dose-volume histograms — once per course; includes the teletherapy isodose plan | Three-dimensional conformal plan including dose-volume histograms — once per course; includes the teletherapy isodose plan |
| 77301 | IMRT planIntensity-modulated treatment plan (plan + MLC optimization) | Intensity-modulated treatment plan (plan + MLC optimization) |
| 77338 | MLC device for IMRTDesign and construction of the multileaf collimator devices for an IMRT plan — reported once per IMRT plan | Design and construction of the multileaf collimator devices for an IMRT plan — reported once per IMRT plan |
| 77331 | Special dosimetrySpecial measurements such as TLD or microdosimetry (e.g., patient-specific IMRT/SRS QA) | Special measurements such as TLD or microdosimetry (e.g., patient-specific IMRT/SRS QA) |
| 77332 – 77334 | Treatment devicesDesign and construction of simple / intermediate / complex devices (blocks, bolus, compensators, molds) | Design and construction of simple / intermediate / complex devices (blocks, bolus, compensators, molds) |
| 77336 | Continuing medical physics consultOngoing physics review of the course, documented weekly | Ongoing physics review of the course, documented weekly |
| 77321 | Special teletherapy port planParticles, total-body or hemi-body irradiation, and other special port plans | Particles, total-body or hemi-body irradiation, and other special port plans |
| 77370 | Special physics consultPhysics management for complex planning (charged once per course) | Physics management for complex planning (charged once per course) |
| CPT code | Description | Typical use |
|---|---|---|
| 77402 | Treatment delivery, Level 1Simplest delivery — single or multiple electron fields, or 2D photons; includes imaging guidance when performed (effective Jan 1, 2026) | Simplest delivery — single or multiple electron fields, or 2D photons; includes imaging guidance when performed (effective Jan 1, 2026) |
| 77407 | Treatment delivery, Level 2Single-isocenter photon delivery (3D or IMRT) with volumetric planning and normal-tissue constraints — the standard curative level; includes imaging guidance when performed | Single-isocenter photon delivery (3D or IMRT) with volumetric planning and normal-tissue constraints — the standard curative level; includes imaging guidance when performed |
| 77412 | Treatment delivery, Level 3Multiple isocenters with photons, single-isocenter delivery with active motion management (e.g., surface guidance, intrafraction tracking), total skin electrons, or mixed electron/photon fields; includes imaging guidance when performed | Multiple isocenters with photons, single-isocenter delivery with active motion management (e.g., surface guidance, intrafraction tracking), total skin electrons, or mixed electron/photon fields; includes imaging guidance when performed |
| 77401 / 77403 / 77417 / 77418 | Deleted Jan 1, 2026The former per-fraction delivery, port-film, and IMRT-delivery codes were retired when the complexity-based set above took effect | The former per-fraction delivery, port-film, and IMRT-delivery codes were retired when the complexity-based set above took effect |
| 77436 – 77439 | Surface radiation therapy (new Jan 1, 2026)Superficial/orthovoltage planning and setup (77436), superficial delivery ≤150 kV per fraction (77437), orthovoltage delivery >150–500 kV per fraction (77438), and ultrasound guidance for cutaneous tumors once per course (77439) | Superficial/orthovoltage planning and setup (77436), superficial delivery ≤150 kV per fraction (77437), orthovoltage delivery >150–500 kV per fraction (77438), and ultrasound guidance for cutaneous tumors once per course (77439) |
| CPT code | Description | Typical use |
|---|---|---|
| 77301 | IMRT planIMRT treatment planning and optimization | IMRT treatment planning and optimization |
| 77338 | MLC device for IMRTDesign and construction of the MLC devices for the plan — once per IMRT plan | Design and construction of the MLC devices for the plan — once per IMRT plan |
| 77407 / 77412 | IMRT deliverySince Jan 1, 2026, IMRT delivery is billed by complexity — single-isocenter Level 2 (77407), or Level 3 (77412) with active motion management; imaging guidance is included in the delivery code | Since Jan 1, 2026, IMRT delivery is billed by complexity — single-isocenter Level 2 (77407), or Level 3 (77412) with active motion management; imaging guidance is included in the delivery code |
| 77331 | Special dosimetry (IMRT QA)Patient-specific IMRT QA measurement and validation | Patient-specific IMRT QA measurement and validation |
| 77385 / 77386 | Deleted Jan 1, 2026The former IMRT guidance-and-tracking codes (simple/complex) were retired and folded into the delivery codes and 77387 | The former IMRT guidance-and-tracking codes (simple/complex) were retired and folded into the delivery codes and 77387 |
| CPT code | Description | Typical use |
|---|---|---|
| 77387 | Image guidance — single IG codeThe one image-guidance code for all treatment delivery (professional component only as of Jan 1, 2026); the technical component is bundled into 77402/77407/77412 | The one image-guidance code for all treatment delivery (professional component only as of Jan 1, 2026); the technical component is bundled into 77402/77407/77412 |
| 77014 / 77417 | Deleted Jan 1, 2026CBCT guidance and port-film verification codes were retired — imaging guidance now rides with the delivery codes and 77387 | CBCT guidance and port-film verification codes were retired — imaging guidance now rides with the delivery codes and 77387 |
| 76377 | Image fusion (planning IGRT)Fusing verification imaging, prior scans, or MRI for adaptive IGRT | Fusing verification imaging, prior scans, or MRI for adaptive IGRT |
| 77293 | Respiratory motion simulation (add-on)Physician work for motion management at simulation, supporting motion-managed delivery | Physician work for motion management at simulation, supporting motion-managed delivery |
| CPT code | Description | Typical use |
|---|---|---|
| 77371 | SRS — complete course, 1 session (cobalt-60 multisource)Cranial stereotactic radiosurgery delivered in a single session on a Gamma Knife-type unit | Cranial stereotactic radiosurgery delivered in a single session on a Gamma Knife-type unit |
| 77372 | SRS — complete course, 1 session (linac-based)Cranial stereotactic radiosurgery delivered in a single session on a linear accelerator | Cranial stereotactic radiosurgery delivered in a single session on a linear accelerator |
| 77373 | SBRT delivery, per fractionStereotactic body RT delivery with image guidance, per fraction — the whole course may not exceed 5 fractions | Stereotactic body RT delivery with image guidance, per fraction — the whole course may not exceed 5 fractions |
| 77432 | SRS treatment managementProfessional management of a cranial SRS course delivered in one session | Professional management of a cranial SRS course delivered in one session |
| 77435 | SBRT treatment managementProfessional management of an SBRT course of up to 5 fractions | Professional management of an SBRT course of up to 5 fractions |
| 77470 | Special treatment procedureAdd-on for complex multimodality / stereotactic courses (once per course) | Add-on for complex multimodality / stereotactic courses (once per course) |
| CPT code | Description | Typical use |
|---|---|---|
| 77761 | HDR intracavitary, simpleRemote afterloading HDR intracavitary application, 1–4 sources (or 1 channel); includes basic dosimetry | Remote afterloading HDR intracavitary application, 1–4 sources (or 1 channel); includes basic dosimetry |
| 77762 | HDR intracavitary, intermediateHDR intracavitary application, 5–10 sources (or 2–12 channels) — e.g., tandem and ovoids; includes basic dosimetry | HDR intracavitary application, 5–10 sources (or 2–12 channels) — e.g., tandem and ovoids; includes basic dosimetry |
| 77763 | HDR intracavitary, complexHDR intracavitary application, more than 10 sources (or more than 12 channels); includes basic dosimetry | HDR intracavitary application, more than 10 sources (or more than 12 channels); includes basic dosimetry |
| 77767 / 77768 | HDR skin surface, simple / complexRemote afterloading HDR skin-surface brachytherapy (e.g., skin cancer applicators) | Remote afterloading HDR skin-surface brachytherapy (e.g., skin cancer applicators) |
| 77770 / 77771 / 77772 | HDR interstitial or intracavitaryRemote afterloading HDR interstitial or intracavitary treatment, 1–4 / 5–10 / more than 10 sources; includes basic dosimetry | Remote afterloading HDR interstitial or intracavitary treatment, 1–4 / 5–10 / more than 10 sources; includes basic dosimetry |
| 77776 / 77777 / 77778 | LDR interstitial, simple / intermediate / complexLow-dose-rate interstitial source application; the complex level covers the larger implants such as a prostate seed implant | Low-dose-rate interstitial source application; the complex level covers the larger implants such as a prostate seed implant |
| 77789 | Surface application, LDR radioelementSurface application of a low-dose-rate radioelement (e.g., Sr-90 eye plaque) | Surface application of a low-dose-rate radioelement (e.g., Sr-90 eye plaque) |
| 77790 | Supervision of loading / adjustmentTechnical-component-only code for loading and adjusting radioactive elements | Technical-component-only code for loading and adjusting radioactive elements |
| 0395T | Electronic brachytherapy, per fractionHigh-dose-rate electronic brachytherapy, interstitial or intracavitary, per fraction; includes basic dosimetry | High-dose-rate electronic brachytherapy, interstitial or intracavitary, per fraction; includes basic dosimetry |
| 77316 / 77317 / 77318 | Brachytherapy isodose plansSimple / intermediate / complex brachytherapy dosimetry planning | Simple / intermediate / complex brachytherapy dosimetry planning |
| 77799 | Unlisted brachytherapy procedureReporting brachytherapy not described by another code | Reporting brachytherapy not described by another code |
| CPT code | Description | Typical use |
|---|---|---|
| 77427 | Radiation treatment management, 5 treatmentsProfessional weekly management — one unit per 5 fractions (the main weekly code) | Professional weekly management — one unit per 5 fractions (the main weekly code) |
| 77431 | Complete course management, 1–2 fractions onlyA whole course consisting of only one or two fractions (e.g., a single palliative fraction) | A whole course consisting of only one or two fractions (e.g., a single palliative fraction) |
| 77432 | SRS management, one sessionProfessional management of a completed cranial stereotactic radiosurgery course | Professional management of a completed cranial stereotactic radiosurgery course |
| 77435 | SBRT managementProfessional management of a stereotactic body RT course of up to 5 fractions | Professional management of a stereotactic body RT course of up to 5 fractions |
| 77469 | Intraoperative RT managementProfessional management when treatment is delivered during surgery (IORT) | Professional management when treatment is delivered during surgery (IORT) |
| 77470 | Special treatment procedureAdd-on for special procedures such as TBI, total skin electrons, or stereotactic courses — once per course | Add-on for special procedures such as TBI, total skin electrons, or stereotactic courses — once per course |
| CPT code | Description | Typical use |
|---|---|---|
| 77424 / 77425 | Intraoperative RT delivery, single sessionIORT delivered with X-rays (77424) or electrons (77425) during surgery | IORT delivered with X-rays (77424) or electrons (77425) during surgery |
| 77470 | Special treatment procedureComplex course add-on: TBI, total skin electron, stereotactic — once per course | Complex course add-on: TBI, total skin electron, stereotactic — once per course |
| 77499 | Unlisted therapeutic radiology procedureCoding for procedures without a specific CPT code | Coding for procedures without a specific CPT code |
| 77387 | Image guidance, professional componentThe single professional image-guidance code for all delivery since 2026 — see the IGRT section | The single professional image-guidance code for all delivery since 2026 — see the IGRT section |
| 77370 | Special physics consultPhysics management for complex setups (e.g., TBI, electron arc) | Physics management for complex setups (e.g., TBI, electron arc) |
Many radiation oncology codes split into a professional component (physician work, modifier -26) and a technical component (facility/equipment, modifier -TC). Billing globally (without modifier) includes both; hospital outpatient billing often separates them.
77427 is the standard weekly management code, billed for every 5 fractions delivered. For very short courses (SRS, palliative), use the complete-course management codes (77431 – 77438) instead of weekly 77427.
Curative courses in freestanding centers may be billed globally. Hospital outpatient departments typically bill the technical component under the hospital (APC) and the physician bills the professional component (-26).
-26 professional component · -TC technical component · -59 distinct procedural service · -52 reduced services · -22 increased procedural service · -76 repeat procedure by same physician. Use -59 to unbundle distinct services performed the same day.
The number of targets, complexity of blocking, dosimetry calculations, and number of fractions determine the planning (77295 / 77301 / 77306–77307), delivery (77402/77407/77412 complexity levels), and management (77427, 77431, 77432, 77435) levels billed.
The AMA and CMS revise the radiation oncology code set periodically — most recently the January 1, 2026 restructuring of treatment delivery into three complexity-based codes (77402/77407/77412) with a single professional image-guidance code (77387). Always verify against the current CPT and Medicare Physician Fee Schedule, and check payer-specific coverage rules.