Major Radiation Oncology Code Changes in 2026
Emilio Beatley, Senior Health Policy Analyst, ASTROThe landscape of radiation oncology coding and reimbursement is undergoing its most significant shift in over a decade, after ASTRO led the radiation oncology community in a critical advocacy campaign to support its members. With ongoing Medicare payment cuts and increased practice expenses, the financial stability of radiation oncology practices is at stake.
At the start of 2026, the introduction of new radiation treatment delivery and image guidance coding and the revaluation of practice expense across all medical specialties will dramatically impact reimbursement rates. Understanding these changes is essential to business planning for radiation oncology practices and highlights the need to engage in advocacy to ensure that patients have access to high-quality care.
What Happened?
In 2024, the AMA CPT Editorial Panel approved significant changes to radiation oncology treatment delivery and image guidance codes. These changes reflect advances in technology and care delivery, which can dramatically impact how these services will be valued under the Medicare Physician Fee Schedule (MPFS) and Hospital Outpatient Payment system. ASTRO was actively engaged in the CPT and RUC (Relative Value Scale Update Committee) processes, advocating for radiation oncology’s unique needs to be accounted for in these discussions.The treatment delivery codes have been consolidated into three levels of complexity (77402, 77407, and 77412), regardless of site of service (hospital or freestanding). In addition to the deletion of 77385 and 77386, all the G-codes for delivery previously reported under the MPFS also have been deleted. Image guidance for all treatment delivery has been consolidated into a single code: 77387. The code 77387 will be a professional code only, as the technical component is now bundled into reimbursement for the updated delivery codes.
| CPT Code | Description | Changes |
|---|---|---|
| 77402 | Radiation treatment delivery; Level 1 (for example, single electron field, multiple electron fields, or 2D photons), including imaging guidance, when performed | Revised to consolidate and more clearly specify services provided for radiation treatment delivery |
| 77407 | Radiation treatment delivery; Level 2, single isocenter (e.g., 3D or IMRT), photons, including imaging guidance, when performed | |
| 77412 | Radiation treatment delivery; Level 3, multiple isocenters with photon therapy (for example, 2D, 3D, or IMRT) OR a single isocenter photon therapy (e.g., 3D or IMRT) with active motion management, OR total skin electrons, OR mixed electron/photon field(s), including imaging guidance, when performed | |
| 77014 | Computed tomography guidance for placement of radiation therapy fields | Deleted |
| 77385 | Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple | Deleted |
| 77386 | Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex | Deleted |
What this Means for Providers and Patients
The treatment delivery code and image guidance changes, as well as the practice expense update, will impact how radiation therapy is paid for, and it is crucial that providers understand what may be coming:- Financial implications: shifts in reimbursement rates.
- Operational adjustments: modifications to billing processes, requiring training for administrative and clinical staff.
ASTRO is pleased that Medicare acknowledged longstanding payment concerns by agreeing to use hospital outpatient payments to inform MPFS payments. ASTRO successfully advocated for better balance in MPFS reimbursement for freestanding centers from what was initially proposed by Medicare. In addition, ASTRO secured improved Ambulatory Payment Classification (APC) assignments for hospitals. Advocacy in support of the Radiation Oncology Case Rate Act is still essential to secure long-term payment stability for the specialty.
| Final Rule RVUs | MPFS Payment Rate | 2025 APC Assignment | 2026 APC Assignment | |
|---|---|---|---|---|
| 77402 | 2.38 | $79.49 | 5621 ($109.50) | 5621 ($104.24) |
| 77407 | 9.51 | $317.64 | 5622 ($262.98) | 5622 ($394.05) |
| 77412 | 11.72 | $391.46 | 5622 ($262.98) | 5623 ($564.51) |
Definitions
It is important to understand that the updated delivery codes no longer distinguish between 3D and IMRT delivery and instead are based on the complexity of the treatment delivery itself. Active motion management and multiple isocenters with photons are indicators for when it is appropriate to bill CPT 77412 for the most complex delivery.Active Motion Management: Treatment delivery with active motion management (CPT® code 77412) includes intrafraction localization and tracking of the target(s) or patient motion to optimize beam delivery (e.g., intrafraction motion, surface guidance).
Intrafraction motion management utilizes fiducials or imaging to monitor the target or organs at risk during the breathing cycle (e.g., during a deep inspiration breath hold). This method minimizes organ motion and allows more accurate delivery of radiation to mobile targets and active avoidance of organs at risk.
Isocenter: As a starting point, the patient is positioned as specified in the plan to the reference point of the treatment machine’s coordinate system (identified by the term isocenter).
Prior to treatment delivery, the patient’s position relative to the isocenter requires image verification. If a shift in the patient’s position relative to the isocenter is necessary for additional treatment volumes, as described in the isodose plan(s), this would be a second isocenter.
