2026 Radiation Treatment Delivery Codes: 77402, 77407, 77412

For 2026 dates of service, the codes that carried most of a radiation oncology practice’s revenue no longer exist. The IMRT delivery codes 77385 and 77386, the image guidance codes 77014 and G6001 to G6017, and the 2D/3D code 77401 were deleted on January 1, 2026, and external beam delivery is now reported with the 2026 radiation treatment delivery codes 77402, 77407 and 77412, chosen by complexity rather than by technique. Image guidance moved inside those codes, with only the physician’s work left on its own line as 77387-26. If your charge master, payer contracts and authorization lists still use the old codes, this is the change to fix first.

The first year has had problems. If your January remits looked wrong, many other practices saw the same thing.

The deletion map

Deleted January 1, 2026	What it reported	Where it went
77385, 77386	IMRT delivery, simple and complex	77407 (single isocenter, no motion management) or 77412 (any Level 3 criterion met)
77401	Superficial or orthovoltage delivery	77437 or 77438 in the new surface radiation therapy family
77014	CT image guidance	Technical work bundled into 77402, 77407 and 77412; professional component reported as 77387-26
G6001 to G6017	Medicare’s HCPCS series for treatment delivery and image guidance	77402, 77407, 77412 and 77387-26

The three delivery levels

The level is set by what the delivery required, not by whether the plan was 3D or IMRT. The 2026 CPT descriptors read, in short:

Code	Level	Descriptor, abridged
77402	Level 1	Single electron field, multiple electron fields, or single-isocenter 2D photons, including imaging guidance when performed
77407	Level 2	Single-isocenter photons (for example 3D or IMRT), including imaging guidance when performed
77412	Level 3	Multiple isocenters with photon therapy, or single-isocenter photons with active motion management, or total skin electrons, or mixed electron and photon fields, including imaging guidance when performed

Any one Level 3 criterion is enough; a case does not need two. Active motion management means something beyond setup verification: respiratory gating, deep inspiration breath hold, surface guidance and 4D cone beam CT are the examples the Cureus review gives. Daily image guidance by itself does not make a course Level 3. UnitedHealthcare’s commercial policy states that when 77412 is reported, the documentation must clearly describe the circumstances that justify Level 3 rather than Level 2.

Scenario (from the Cureus review)	Code
Left breast with deep inspiration breath hold or surface guidance	77412
Humerus and femur metastases treated in the same session (two isocenters)	77412
Prostate IMRT with nodes, single isocenter	77407
Head and neck IMRT, single isocenter	77407, typically
Simple en face electron field to the skin	77402

77387: one line, professional only

CPT 77387 was repurposed as the professional component of image guidance, not including motion management. Its technical component carries status indicator B under the physician fee schedule, meaning bundled and not separately payable, so a freestanding center bills 77387 with modifier 26 and no technical line, and in a hospital the physician is the only party who reports it. The code’s work RVU moved from 0.85 to 0.70 in the RUC survey and landed at 0.68 after the 2026 efficiency adjustment.

Payer rules on the line itself vary. UnitedHealthcare and Cigna’s eviCore manual both specify 77387-26; eviCore allows one unit per date of service and does not allow it with SRS or SBRT (77371 to 77373), which include their own image guidance. Neither 77387 nor the delivery codes are reported during superficial therapy.

Superficial therapy gets its own family

Code	Descriptor, abridged
77436	Surface radiation therapy; treatment planning and simulation-aided field setting
77437	Superficial delivery, 150 kV or less, per fraction (for example electronic brachytherapy)
77438	Orthovoltage delivery, more than 150 to 500 kV, per fraction
77439	Ultrasound image guidance for field placement, per course of treatment; add-on to 77437 or 77438

Per the AMA’s exclusionary note, 77436 to 77439 are not reported with 77387, 77402, 77407, 77412, 77427 or the planning and dosimetry codes. High-energy treatment of skin cancer with electrons or photons stays on 77402, 77407 or 77412. An erratum posted March 10, 2026 corrected two typos in that note (77262 and 77263 should read 77762 and 77763).

Worked example: a 20-fraction prostate IMRT course

Single isocenter, daily cone beam CT, no motion management, freestanding center.

Line	2025	2026
Treatment delivery	20 units of 77385 or 77386 (G6015 or G6016 where the payer required the G-codes)	20 units of 77407
Image guidance, technical	20 units of 77014, G6001, G6002 or G6017, depending on payer and modality	None; bundled into 77407
Image guidance, professional	Part of the image guidance line, or its modifier 26 component in a hospital	20 units of 77387-26
Weekly management	4 units of 77427	4 units of 77427

The number of visits is the same, each visit has one fewer technical line, and the delivery code no longer says IMRT. If this patient instead had a left-sided breast course with breath hold, every delivery line would be 77412 and the chart would need to say why. LUGPA’s estimate is that a prostate course billed as 77407 pays 10 to 20 percent less than the 2025 IMRT codes did.

What went wrong in the first months

Palmetto GBA denied 77387 with modifier 26 or TC for early 2026 dates of service because the code had not been loaded as recognized. Palmetto mass adjusted the claims and reported the issue resolved as of March 6, 2026; providers were told no action was needed, but check that the adjustments actually posted.
UnitedHealthcare listed 77387 and 77439 on its bundled codes policy until January 18, 2026, which blocked physician payment for image guidance and surface field verification. Both were removed that day.
Missing fee schedule entries. Some payers had not loaded the new codes, and some reverted to older rates. Some centers also reverted to pre-2015 charge master prices for 77402, 77407 and 77412, which understates charges that now describe a bundled service.
Contract language. Contracts priced off an older CMS base year, lesser-of clauses, and percent-of-charge terms with caps can all underpay codes whose scope grew. 77387 had no fee schedule base rate at all before 2026.
The mix. CMS valued the codes expecting roughly 35 percent of external beam delivery to be Level 3. In the 2027 proposed rule it reported early 2026 claims at about 18 percent, with most delivery billed as 77407. ASTRO’s March 2026 member survey found many practices reporting revenue declines of more than 10 percent.

What to do now

Rebuild the charge master for 77402, 77407, 77412, 77387-26 and 77436 to 77439 at prices that reflect the bundled 2026 descriptors, not the 2015 entries for the same code numbers.
Pull every payer contract that names 77385, 77386, 77014 or a G-code and ask for the 2026 code rates in writing. Check lesser-of and charge-cap clauses while you are there.
Write a Level 3 documentation checklist with the four criteria, and make sure the physician’s note names the one that applies before 77412 goes out.
Check the routing from the treatment system to billing. The ACCC notes that ARIA and MOSAIQ exports to Epic need review so 77387-26 reaches the physician claim and the delivery code reaches the right entity.
Audit January to March remits for 77387-26 denials, 77412 paid at a lower tier, and lines paid at older rates; appeal with the AMA descriptor and your documentation.
Load payer-specific edits. Iridium Suite’s claim scrubber applies payer-specific rules at charge entry, which is where a rule such as “Cigna: 77387 requires modifier 26, one unit per date of service” belongs; see the claim scrubber.

The 2026 radiation treatment delivery codes: what 77402, 77407, 77412 and 77387 mean for your billing