IGRT
Coding Question: What is the official policy on 77417 port images?
Coding Response: Effective January 1, 2026, payment for CPT code 77417 is packaged into the payment for the treatment delivery codes (77402-77412) and is not separately reimbursable in either the physician office/freestanding or hospital setting. CPT 77417 had previously been reimbursed as a technical-only service in the office/freestanding setting.
Coding Question: How do you document IGRT? Is it sufficient to just electronically sign off on the orthogonal images or CBCT for IGRT? I have heard that a daily note is also needed? Do you write a unique daily note to support 77387?
Coding Response: The images and shifts are to be reviewed and approved by the radiation oncologist prior to the patient’s next treatment. Appropriate documentation could be a note in the patient’s chart or a physician’s electronic signature on the shifts/images. A unique daily note is not required.
Coding Question: Can a physician review and electronically sign-off on IGRT images if the physician was not in the facility on the day the imaging was performed? (Example: A physician is out on Friday and returns to work on Monday and reviews IGRT images from that Friday prior to the next scheduled treatments)
Coding Response: To meet the criteria for billing the PC of IGRT, a radiation oncologist must review and approve the IGRT data prior to the next treatment session. The PC work does not need to be completed on-site where the delivery was furnished, however if the PC work is performed off-site, the site of service will remain with the on-site location. As for billing the TC of IGRT, CMS designates that image guidance requires the direct supervision of a physician (on-site and able to furnish assistance if necessary) in both freestanding and hospital settings. The billing system will need to be set up to separate the PC and TC and assign them to the appropriate physicians. If your billing system cannot separately assign the TC and PC components to the appropriate physician, then this may not be feasible in your practice setting. You should consult your compliance office before making a change in your billing pattern.
Coding Question: How do we report image guidance with IMRT and Conventional treatment using the updated CPT code(s) that went into effect 2026?
Coding Answer: Beginning in 2026, Medicare consolidated all image guidance services into a single CPT code-- 77387. Codes G6001, G6002, G6017 and 77014 were all deleted. In addition, the technical component of image guidance is now bundled into the delivery codes (77402-77412) and is not separately reimbursable. Instead, the professional component of 77387 is reported and reimbursed. This applies to all image guidance regardless of modality utilized.
