Picture an IMRT course billed from a 2025 charge sheet in 2026. The claim carries 77386 for delivery and 77014 for CT guidance, and both lines come back, because neither code exists anymore.
The 2026 CPT update rebuilt radiation treatment delivery around three complexity levels and made image guidance a professional-only service. The rest of the course of care, from consult to final management, largely kept its codes. Right after the 2026 changes, a quick-reference table lists every 2026 code by stage of the radiation oncology process of care. The sections after it explain what each code covers and how it splits between professional and technical billing.
What Changed for 2026
Five changes to radiation oncology CPT codes for 2026 drive most of this year’s errors. The ASTRO 2026 code summary lists them, and payers such as Sanford Health Plan have already updated their edits.
- IMRT delivery codes deleted: 77385 and 77386 are gone. IMRT now reports with the level that fits the plan, usually 77407.
- CT guidance deleted: 77014 for placing radiation fields is bundled into the delivery codes.
- Delivery G-codes deleted: G6001 to G6017, used for physician-fee-schedule delivery, are retired. Freestanding centers now bill CPT delivery codes like hospitals.
- Delivery rebuilt by complexity: 77402, 77407 and 77412 now describe Level 1, 2 and 3 delivery, regardless of 3D or IMRT technique.
- Image guidance split: 77387 is now professional component only. Its technical work is built into the delivery codes.
Any charge sheet, EHR charge router or prior authorization template that still lists the deleted codes needs updating before the next claim goes out.
The 2026 Cheat Sheet at a Glance
Every stage of a radiation therapy course, from consult to final treatment, maps to the 2026 codes below. The sections that follow explain each stage.
| Stage | 2026 codes | Key billing rule |
|---|---|---|
| 1. Consult | 99202 to 99205 (Medicare); 99242 to 99245 (many commercial plans) | Medicare does not pay consult codes |
| 2. Clinical treatment planning | 77261, 77262, 77263 | Professional only; level follows documented complexity |
| 3. Simulation | 77280, 77285, 77290; add-on 77293 | PC and TC; repeat only for a documented plan change |
| 4. Dosimetry and devices | 77295, 77300, 77301, 77306, 77307, 77332 to 77334, 77338 | 77301 includes 77295 for the same course |
| 5. Physics | 77336, 77370 | Technical only |
| 6. Treatment delivery | 77402, 77407, 77412 (stereotactic: 77371 to 77373) | Technical only; billed per fraction |
| 7. Image guidance | 77387 | Professional only for 2026 |
| 8. Weekly management | 77427, 77431, 77432, 77435 | One 77427 per five fractions |
| 9. Final treatment and follow-up | No new code | Medicare does not pay routine follow-up for three months after external beam therapy |
No longer valid in 2026: 77385, 77386, 77014, 77401, 0394T and G6001 to G6017. The 2026 NCCI manual confirms these deletions and the stereotactic delivery codes, and ASTRO coding basics confirms the three-month follow-up rule.
Consult and Clinical Treatment Planning
The course starts with an E/M visit. New-patient office codes 99202 to 99205 apply for Medicare, which does not pay consultation codes. Many commercial plans still accept 99242 to 99245.
Once the physician decides to treat, clinical treatment planning captures that decision: target volumes, dose, technique and number of fractions.
| Code | Covers | Billing note |
|---|---|---|
| 77261 | Simple planning: one treatment area, simple port or simple dose | Professional only |
| 77262 | Intermediate planning: three or more converging ports or two separate areas | Professional only |
| 77263 | Complex planning: custom shielding, rotational beams or three or more treatment areas | Professional only; most IMRT and SBRT courses |
The planning level must match the documented complexity, not the delivery technique. Radiation therapy coding guidelines tie the level to the note, so a 77263 with a thin planning note is a frequent audit target.
Simulation, Dosimetry and Devices
This stage turns the plan into beams, and it carries the most separately billable codes in the course.
Simulation: 77280 to 77293
- 77280, simple: one treatment area
- 77285, intermediate: two separate areas
- 77290, complex: three or more areas, brachytherapy simulation, contrast, or 3D/CT simulation
- 77293, respiratory motion management: add-on to 77295 or 77301 when 4D motion is assessed
Resimulation for a plan change can be billed again when documented. All four codes split into professional (-26) and technical (TC) components.
Dosimetry and Device Codes
| Code | Covers | Billing note |
|---|---|---|
| 77295 | 3D plan with dose-volume histograms | Once per course unless the plan changes |
| 77301 | IMRT plan | Includes 77295 and isodose plans for the same course |
| 77300 | Basic dosimetry calculation | Per calculation; not with 77306 or 77307 |
| 77306 / 77307 | Teletherapy isodose plan, simple or complex | Includes basic dose calculation |
| 77332 to 77334 | Treatment devices, simple to complex | Per device; complex covers custom blocks and immobilization molds |
| 77338 | Multileaf collimator design for IMRT | Per IMRT plan |
| 77336 | Continuing medical physics consult | Technical only; once per five fractions |
Device and calculation counts are where missed charges hide. Our post on missed radiation oncology charges shows how to catch them before claims close.
Delivery, Image Guidance and Management
These codes repeat through the course, so a single error multiplies across every fraction.
Treatment Delivery: Pick the Level
Delivery is technical only and billed per fraction. The level depends on isocenters and motion management, not on 3D vs IMRT.
- 77402, Level 1: single or multiple electron fields, or 2D photons
- 77407, Level 2: photons with a single isocenter, whether 3D or IMRT
- 77412, Level 3: photons with multiple isocenters, a single isocenter with active motion management, total skin electrons, or mixed electron and photon fields
A second isocenter counts only when the patient is shifted to treat an additional volume. Stereotactic delivery stays on its own codes, covered in our SBRT billing guide.
Image Guidance: 77387
For 2026, 77387 is professional only and covers the physician’s review of guidance images. Do not bill a technical 77387 or the deleted 77014; that work is now inside the delivery code.
Weekly Treatment Management
- 77427: one unit per five fractions. Three or four fractions left at the end of a course add one more unit; one or two do not.
- 77431: management for a course of only one or two fractions.
- 77432 / 77435: stereotactic management for cranial SRS and SBRT, billed once per course instead of 77427.
All management codes are professional only.
One IMRT Course, Coded End to End
Here is how the codes come together for a 28-fraction, single-isocenter IMRT prostate course in a freestanding center billing globally.
- Consult: 99204 for the new-patient visit.
- Planning: 77263 for complex clinical treatment planning.
- Simulation: 77290 for CT-based simulation.
- Dosimetry and devices: 77301 for the IMRT plan and 77338 for the multileaf collimator design, plus 77300 and 77334 for each calculation and device documented.
- Physics: 77336 × 6, one per five fractions.
- Delivery: 77407 × 28, since one isocenter with no active motion management is Level 2.
- Image guidance: 77387-26 for each fraction with documented physician image review.
- Management: 77427 × 6.
In 2025, this delivery went out as G6015 from a freestanding center or 77386 from a hospital. Neither code is valid on a 2026 claim.
Who Bills What: PC vs TC?
When a physician group and a hospital share a patient, each must bill only its own component. This split shows which side owns each code family in 2026.
| Code family | Professional (-26) | Technical (TC) |
|---|---|---|
| Clinical treatment planning, 77261 to 77263 | Yes | No |
| Simulation, 77280 to 77293 | Yes | Yes |
| Dosimetry and devices, 77295 to 77338 | Yes | Yes |
| Physics consults, 77336 and 77370 | No | Yes |
| Delivery, 77402, 77407 and 77412 | No | Yes |
| Image guidance, 77387 | Yes | No (new for 2026) |
| Treatment management, 77427 to 77435 | Yes | No |
Freestanding centers bill both components globally. For hospital-based arrangements, our guide to professional and technical billing covers the split in detail, and this radiation oncology coding audit shows what component errors cost in practice.
2026 Errors That Trigger Denials
The same mistakes tend to repeat after a code change this large. Each one is easy to catch with a charge-level edit.
- Deleted codes still on the charge master: 77385, 77386, 77014 or G6001 to G6017 on any claim dated 2026.
- Technical 77387: billing a global or TC line for image guidance, which is now professional only.
- Wrong delivery level: reporting 77407 when the plan uses active motion management or a second isocenter, which leaves Level 3 revenue unbilled.
- 77427 miscounts: billing a unit for one or two leftover fractions, or missing the unit for three or four.
- Duplicate planning: reporting 77295 with 77301 for the same course.
- Stale authorizations: prior authorizations still listing the old IMRT codes. Many payers map them, but the claim should carry the 2026 code.
Keep Every Fraction Billable in 2026
Most of the radiation oncology course codes the same as last year. The revenue risk sits in the parts that moved: delivery now follows three complexity levels, IMRT has no codes of its own, and image guidance pays only the professional side. A charge master that still carries 77385, 77386, 77014 or the G-codes will keep producing rejections until it is fixed.
A quick check of a few January to March courses against this sheet usually shows whether the 2026 changes reached every charge. MBW RCM reviews delivery levels, fraction counts and component splits for providers through its radiation oncology billing services, so each fraction delivered is a fraction paid.
Frequently Asked Questions
What replaced 77385 and 77386 in 2026?
IMRT delivery is now reported with the delivery level that fits the plan. A single-isocenter IMRT plan is usually 77407, and multiple isocenters or active motion management move it to 77412.
Is 77014 still billable with radiation therapy?
No. CPT 77014 was deleted for 2026, and CT guidance for field placement is included in 77402, 77407 and 77412.
Can the technical component of 77387 be billed in 2026?
No. 77387 is professional only for 2026. The technical image guidance work is built into the delivery codes.
How many units of 77427 are billed for a 28-fraction course?
Six. Five units cover 25 fractions, and the remaining three fractions add one more unit.