Specialty Billing Built for Radiation Therapy Practices
Radiation therapy billing hinges on pairing IMRT planning 77301 with its delivery code 77407, matching simulation complexity (77295 vs 77290), and capturing IGRT 77387 per fraction. Add the 2026 code overhaul that deleted 77338, 77386, and 77014 in favor of the new 77402/77407/77412 delivery set — and general billers miss revenue on every treatment course. MedFactor delivers radiation oncology-specific RCM that protects every fraction.
Radiation Oncology Practice Types We Support
From external beam and IMRT to brachytherapy and proton therapy, we tailor billing to the coding rules of every radiation oncology subspecialty.
3D-CRT & Conventional
Conventional and 3D conformal delivery with planning 77261–77263 and the new complexity-based delivery codes 77402/77407/77412.
HDR & LDR Brachytherapy
Source placement, dwell-time dosimetry, and fraction billing for HDR and LDR brachytherapy with proper source and planning capture.
Intensity-Modulated RT
IMRT planning 77301 paired with delivery 77407 and image guidance 77387, with dose-volume histogram documentation.
Stereotactic Radiotherapy
SBRT 77373 and cranial SRS 77372 with the 5-fraction course rule and hypofractionated delivery documentation.
Proton Beam Delivery
Proton beam delivery with modulator complexity and treatment-device billing across proton therapy courses.
Pediatric Radiation Oncology
Age-based anesthesia coordination, sedation billing, and pediatric fraction protocols with consent and dosimetry capture.
IMRT Planning & Delivery Stack
An IMRT course is billed as a planning code (77301) that must be paired with its delivery code (77407) — and the 2026 code overhaul deleted the legacy 77338/77386 delivery codes and 77014 CT guidance in favor of 77402/77407/77412 and 77387. Billing planning without delivery (or vice versa) is the single largest source of radiation therapy denials.
Planning Tier + Delivery Tier + Distinct Components
One IMRT course stacks a treatment planning code, an IMRT planning code, then the complexity-based delivery code, with image guidance billed as a distinct professional component.
Why Radiation Therapy Practices Lose Revenue
Radiation therapy billing is governed by planning/delivery pairing, simulation complexity levels, and the 2026 delivery-code overhaul that general billing companies cannot navigate effectively.
Planning/Delivery Mismatch
IMRT plan 77301 billed without its delivery code 77407, or delivery billed without the planning code — losing one side of the paired revenue.
Simulation Level Errors
CT-based simulation 77295 billed as simple 77280 or complex 77290, mismatched to the documented simulation complexity.
IGRT Support Gaps
Image guidance 77387 billed without per-fraction documentation supporting the professional component.
Fraction Count Errors
Delivery units miscounted against the treatment course, under- or over-billing the number of fractions delivered.
Device Code Bundling
Treatment device 77334 and dosimetry 77300 denied as bundled into planning when billed without supporting detail.
Medical Necessity / DOS
Diagnosis (C50, C61, C34) and date-of-service gaps on planning and delivery claims, triggering medical-necessity denials.
Common Radiation Therapy Billing Codes
Quick reference for the most frequently used codes in radiation oncology billing and coding — reflecting the 2026 delivery-code overhaul.
| Code | Description | Common Use |
|---|---|---|
| 77263 | Radiation treatment planning, complex | Complex course planning |
| 77295 | Therapeutic radiology simulation, CT-based | CT simulation for planning |
| 77301 | IMRT plan, including dose-volume histograms | IMRT planning anchor code |
| 77300 | Dosimetry calculation, central axis | Dose calculation per course |
| 77331 | Special dosimetry (special physics consult) | Special physics/dosimetry review |
| 77334 | Treatment device design (MLC) | MLC / treatment device planning |
| 77407 | Radiation delivery, level 2 (single-isocenter IMRT/VMAT) | Workhorse IMRT delivery |
| 77412 | Radiation delivery, level 3 (multi-isocenter / motion management) | Complex IMRT delivery |
| 77373 | SBRT delivery, per fraction (≤5 fractions) | Stereotactic body RT delivery |
| 77387 | Image guidance (IGRT), professional component | Image guidance per fraction |
| Code | Description | Clinical Context |
|---|---|---|
| C50 | Malignant neoplasm of breast | Breast cancer radiation |
| C61 | Malignant neoplasm of prostate | Prostate cancer radiation |
| C34 | Malignant neoplasm of bronchus / lung | Lung cancer radiation |
| C18 | Malignant neoplasm of colon | Colon / abdominal radiation |
| C71 | Malignant neoplasm of brain | Brain / cranial SRS |
| C67 | Malignant neoplasm of bladder | Bladder cancer radiation |
| C73 | Malignant neoplasm of thyroid | Head & neck radiation |
| C56 | Malignant neoplasm of ovary | Pelvic radiation |
| C16 | Malignant neoplasm of stomach | Upper GI radiation |
| Z51.0 | Encounter for radiation therapy | Radiation therapy encounter |
| Modifier | Description | Radiation Therapy Application |
|---|---|---|
| 26 | Professional component | Planning & dosimetry interpretation (77387 IGRT) |
| TC | Technical component | Delivery & equipment component |
| 59 | Distinct procedural service | Distinct planning/delivery sessions |
| 52 | Reduced services | Reduced fraction course |
| 53 | Discontinued procedure | Course discontinued mid-treatment |
| 77 | Repeat by another physician | Re-planning by a different provider |
| 22 | Increased procedural service | Unusually complex planning |
| 76 | Repeat procedure by same physician | Repeat planning / dosimetry |
End-to-End Radiation Therapy RCM
Comprehensive revenue cycle management designed specifically for radiation oncology practices.
Radiation Therapy Billing & Coding
Specialty coders handle planning 77261–77263, IMRT 77301, delivery 77402/77407/77412, and IGRT 77387 with 2026 code-set accuracy.
Denial Management & Appeals
Planning/delivery mismatch defense, simulation-level corrections, and IGRT-support appeals with per-fraction documentation.
Planning/Delivery Pairing Compliance
Every 77301 plan verified against its 77407/77412 delivery code, preventing the single largest radiation therapy denial.
Brachytherapy Coding
HDR/LDR source placement, dwell-time dosimetry, and fraction billing with proper source and planning capture.
A/R Recovery & Follow-Up
Prioritized follow-up on aged planning, delivery, and IGRT claims with strategic payer escalation to maximize recovery.
Analytics & Reporting
Real-time dashboards tracking planning/delivery pairing, IGRT capture, fraction counts, and physician productivity.
Where Radiation Therapy Revenue Leaks
Understanding the most common denial reasons is the first step to preventing them on planning, delivery, and image-guidance claims.
Planning/Delivery Mismatch Denials
IMRT plan 77301 billed without its delivery code 77407, or delivery billed without the planning code.
Our Fix
Pair every 77301 plan with its 77407/77412 delivery code on the same course.
Simulation Level Denials
CT-based simulation 77295 billed as 77290 complex, mismatched to documented simulation complexity.
Our Fix
Match simulation level (77280/77290/77295) to the documented complexity.
IGRT Support Denials
Image guidance 77387 billed without per-fraction documentation supporting the professional component.
Our Fix
Document image guidance per fraction and bill 77387 with supporting detail.
Device/Dosimetry Bundling Denials
Treatment device 77334 and dosimetry 77300 denied as bundled into the planning code.
Our Fix
Bill 77334/77300 with supporting detail establishing the distinct service.
Where Radiation Therapy Practices Lose Money
Identifying and plugging these common revenue leakage points can significantly improve your practice’s bottom line.
Delivery Codes Dropped
77407 fractions not billed per session on the treatment course.
IGRT Not Captured
77387 professional image-guidance component missed per fraction.
Planning Under-Billed
77263 complex planning billed as 77261 simple, losing complexity revenue.
Simulation Miscoded
77295 CT simulation billed as 77290, losing CT-based simulation revenue.
Without vs. With MedFactor
See how radiation oncology-specific revenue cycle management transforms your practice’s financial performance.
Without Specialty RCM
- ✕IMRT plan 77301 billed without its delivery code 77407
- ✕Simulation level mismatched to documented complexity
- ✕IGRT 77387 not documented or billed per fraction
- ✕Treatment device 77334 denied as bundled into planning
- ✕Brachytherapy source and dwell-time dosimetry not captured
- ✕Fraction counts miscounted on delivery claims
- ✕No visibility into planning/delivery pairing or IGRT capture
With MedFactor Radiation Therapy RCM
- ✓Every 77301 plan paired with 77407/77412 delivery on the course
- ✓Simulation 77295/77290 matched to documented complexity
- ✓IGRT 77387 documented and billed per fraction
- ✓Treatment device 77334 and dosimetry 77300 billed with supporting detail
- ✓Brachytherapy source, dwell-time, and dosimetry fully captured
- ✓Fraction counts verified against the treatment course
- ✓Real-time dashboards tracking planning/delivery pairing and IGRT capture
Your Path to Optimized Revenue
A structured onboarding process designed to deliver measurable improvements within the first 90 days.
Discovery & Audit
Review of radiation billing operations, planning/delivery pairing, IGRT capture, and revenue cycle baseline.
Setup & Integration
RO system (Aria/Mosaiq) integration, dedicated radiation oncology billing team, and payer enrollment verification.
Go-Live Operations
Full billing with real-time claim submission, fraction tracking, and denial prevention protocols.
Optimization
Performance review against baseline, workflow optimization, and documented revenue improvement.
MedFactor vs. Other Options
How our radiation oncology-specific approach compares to in-house billing and general medical billing companies.
| Capability | In-House Team | General Billing Co. | MedFactor RT |
|---|---|---|---|
| IMRT planning/delivery pairing (77301/77407) | Inconsistent | ✕ | ✓ |
| 2026 delivery codes (77402/77407/77412) | ✕ | ✕ | ✓ |
| Simulation level selection (77295/77290) | Inconsistent | ✕ | ✓ |
| IGRT 77387 per-fraction capture | ✕ | ✕ | ✓ |
| SBRT 77373 5-fraction rule | Manual | Partial | ✓ |
| Brachytherapy source/dosimetry billing | Inconsistent | Partial | ✓ |
| Fraction count tracking | Manual | Partial | ✓ |
| Planning/delivery pairing reporting | ✕ | ✕ | ✓ |
| Dedicated radiation oncology billing team | ✕ | ✕ | ✓ |
Why Radiation Therapy Practices Trust MedFactor
Our team combines deep radiation oncology billing expertise with the technology and processes to deliver consistent, measurable results for external beam, IMRT, SBRT, and brachytherapy practices.
- AAPC-certified coders with radiation oncology and medical-physics coding experience
- Dedicated radiation oncology billing teams — no generalists rotating through your account
- Real-time claim tracking with planning/delivery pairing and IGRT-capture visibility
- Proven 41% average denial reduction within first 90 days
- Compliance program aligned with the 2026 code overhaul (77402/77407/77412 and 77387)
- smooth integration with Aria, Mosaiq, and major RO EMR systems
Get Your Free Radiation Therapy Billing Audit
Discover exactly where your radiation oncology practice is losing revenue. Our no-obligation audit analyzes your planning/delivery pairing, simulation levels, and IGRT capture.
- IMRT planning/delivery pairing assessment
- Simulation level (77295/77290) review
- IGRT 77387 per-fraction capture check
- Fraction count and 2026 delivery-code audit
Radiation Oncology Practices We’ve Transformed
Real results from radiation therapy practices that partnered with MedFactor for specialty revenue cycle management.
Radiation Group Recovers IMRT Planning Revenue
A radiation oncology group was under-billing complex planning as 77261 instead of 77301 and dropping the IMRT plan entirely. MedFactor implemented planning/delivery pairing, recovering substantial IMRT planning revenue in seven months.
Clinic Fixes Delivery Code Accuracy
A clinic was billing the deleted 77386 IMRT delivery code and dropping IGRT 77387 entirely. MedFactor migrated them to the 2026 77407 delivery set and captured image guidance per fraction, recovering delivery revenue per course.
Multi-Modality Center Grows Revenue
A multi-modality center offering IMRT, SBRT, and brachytherapy was miscoding across modalities. MedFactor standardized delivery codes and brachytherapy source billing, lifting total revenue across all treatment lines.
Radiation Therapy RCM Across All 50 States
No matter where your radiation oncology practice operates, our team understands the payer landscape and regulatory requirements in your region.
Medicare APC Packaging
Hospital outpatient APC packaging rules for the 2026 delivery and image-guidance codes applied correctly.
IGRT Coverage Policy
Payer IGRT 77387 coverage and professional-component rules applied across all 50 states.
Brachytherapy Rules
Brachytherapy source, dwell-time, and dosimetry coverage and prior-auth rules by region.
Proton Therapy Coverage
Proton therapy coverage policy, prior authorization, and modulator-complexity billing by region.
Radiation Therapy Billing Questions Answered
Common questions from radiation oncology practices considering MedFactor’s specialty RCM services.
IMRT planning (77301) is the physics plan that builds the dose-volume histograms and beam arrangements for an IMRT course — it is billed once per course (typically once per 60 days). IMRT delivery (77407) is the per-fraction treatment delivery code billed for each session the patient is treated. The two must be paired on the same course: 77301 without 77407 loses the delivery revenue, and 77407 without 77301 is denied as unsupported by a plan. Under the 2026 code overhaul, the legacy delivery codes 77338 and 77386 were deleted and replaced by the complexity-based 77402/77407/77412 set — 77407 is the single-isocenter IMRT/VMAT workhorse, while 77412 covers multi-isocenter or motion-managed courses.
Treatment planning is billed at three complexity levels: 77261 (simple, single treatment area, straightforward beam arrangement), 77262 (intermediate, multiple treatment areas or blocking), and 77263 (complex, multiple treatment areas, custom blocking, heterogeneity corrections, and dose optimization). The level is selected by the documented complexity of the plan — not the treatment site. We match the planning level to the documented physics work so complex IMRT courses are billed as 77263 rather than under-leveled as 77261, which is a common revenue-loss point.
Simulation codes run from 77280 (simple), 77290 (complex), to 77295 (CT-based simulation). 77295 is billed when a CT scan is used for simulation and treatment-field design — the standard for modern IMRT, SBRT, and 3D-CRT courses that require CT-derived anatomy. The technical component of CT guidance (formerly 77014) is now bundled into 77295 and the new delivery codes under the 2026 overhaul. We select 77295 whenever CT-based simulation is documented and match it to the treatment-planning level on the same course.
SBRT delivery (77373) is billed per fraction to one or more lesions, and the entire course cannot exceed 5 fractions — if the sum of treatment days for all sites treated in a single course exceeds 5 fractions, 77373 is not appropriate. The technical component of image guidance is bundled into 77373, so cone-beam CT and other IGRT guidance are not separately billable on the technical side; only the professional component of image guidance (77387 with modifier 26) may be separately billable depending on payer and setting. We track the fraction count per course against the 5-fraction limit and document image guidance per fraction so SBRT is paid correctly.
Image guidance (IGRT) is the imaging performed at each treatment session to verify patient positioning and target localization before delivery. Under the 2026 code overhaul, the legacy CT-guidance code 77014 was deleted, and 77387 now represents the professional component of image guidance — the technical component is bundled into the delivery codes 77402, 77407, and 77412. We bill 77387 (professional component) with per-fraction documentation showing the physician involvement in image guidance and target verification, so the professional image-guidance revenue is captured rather than lost with the retired 77014.
We integrate with all major radiation oncology information systems (ROIS) and treatment-management platforms including Varian Aria, Elekta Mosaiq, Epic, Cerner, and other RO EMR systems. Our team works with your treatment-planning data, dose-volume histograms, simulation images, and per-fraction delivery records so the planning/delivery pairing, IGRT capture, and fraction counts flow cleanly to correct claim submission — including the 2026 delivery-code selection (77402/77407/77412) that drives accurate radiation oncology coding.
Explore More RCM Specialties
MedFactor applies the same code-level precision across the full practice spectrum. See how we bill these related specialties.
CPT®, ICD-10, HCPCS, and modifier codes referenced on this page reflect the current code sets, including the 2026 radiation oncology delivery-code overhaul (77402/77407/77412 and 77387), and are subject to annual updates — always verify against the current-year fee schedule before submission. KPIs and case-study figures shown are representative benchmarks, not guarantees of individual practice results.
Sources and further reading
The rules these pages describe are published. Check them against the primary sources:
- CMS Physician Fee Schedule, which covers the published rates and payment rules behind most of the codes these pages discuss.
- CMS Physician Self-Referral (Stark Law), which covers the rules governing referrals between a practice and its own ancillary services.
- AAPC, which covers the coding and billing standards body whose credentialing most billers hold.
- HHS Office of Inspector General, which covers enforcement guidance on billing compliance and the areas it targets.
Stop Losing Revenue on Every Treatment Course
Your radiation oncology practice deserves billing partners who know IMRT planning/delivery pairing, the 2026 delivery-code set, and IGRT capture — and code every fraction correctly. Let MedFactor show you what specialty RCM can do.