The 2027 Medicare final rules for radiation oncology: 77407 moves up an APC, delivery codes rise, planning falls
CMS released the CY 2027 physician fee schedule and hospital outpatient (OPPS) final rules on November 4, 2026. The 2027 Medicare final rule for radiation oncology keeps the direction of the July proposals: delivery codes go up, planning and management go down, and the conversion factor falls. The largest change is in the hospital. CMS moved 77407 into APC 5623, the APC 77412 is in, which raises hospital payment for the most billed delivery code by about 36 percent.
Both rules take effect January 1, 2027. All amounts below are national, before geographic adjustment, before the 80 percent Medicare share and before the 2 percent sequester.
The two rules
| CY 2027 Physician Fee Schedule | CY 2027 OPPS and ASC | |
|---|---|---|
| Rule number | CMS-1848-F | CMS-1850-F |
| Released | November 4, 2026 | November 4, 2026 |
| Headline | Conversion factor $32.63 (non-QP), down 2.31 percent | Payment update +2.3 percent |
| Effective | January 1, 2027 | January 1, 2027 |
The conversion factor
| 2026 | 2027 final | Change | |
|---|---|---|---|
| Qualifying APM participants (QP) | $33.57 | $32.95 | -$0.62 (-1.83%) |
| All other clinicians (non-QP) | $33.40 | $32.63 | -$0.77 (-2.31%) |
The drop is larger than proposed ($32.84 non-QP). The 2.50 percent one-year increase for 2026 has ended, and the statutory updates of 0.75 percent (QP) and 0.25 percent (non-QP) do not make up for it. Every 2027 line is priced from the lower factor.
Fee schedule: freestanding centers
Amounts are total non-facility RVUs times the non-QP conversion factor ($33.4009 for 2026, $32.63 for 2027).
| Code | 2026 RVUs | 2027 RVUs | 2026 amount | 2027 amount | Change |
|---|---|---|---|---|---|
| 77402 delivery, Level 1 | 2.46 | 2.98 | 82.17 | 97.24 | +18.3% |
| 77407 delivery, Level 2 | 9.28 | 10.43 | 309.96 | 340.33 | +9.8% |
| 77412 delivery, Level 3 | 13.28 | 14.52 | 443.56 | 473.79 | +6.8% |
| 77387 image guidance | 1.09 | 1.08 | 36.41 | 35.24 | -3.2% |
| 77427 weekly management | 5.85 | 5.73 | 195.40 | 186.97 | -4.3% |
| 77263 complex planning | 5.04 | 4.95 | 168.34 | 161.52 | -4.1% |
| 77290 complex simulation | 13.22 | 12.64 | 441.56 | 412.44 | -6.6% |
| 77301 IMRT plan | 58.69 | 56.20 | 1,960.30 | 1,833.81 | -6.5% |
| 77338 MLC device | 14.22 | 13.74 | 474.96 | 448.34 | -5.6% |
| 77373 SBRT delivery | 29.30 | 27.87 | 978.65 | 909.40 | -7.1% |
| 77435 SBRT management | 19.20 | 18.84 | 641.30 | 614.75 | -4.1% |
| 77770 HDR brachytherapy, 1 channel | 10.46 | 10.05 | 349.37 | 327.93 | -6.1% |
The changes above include the lower conversion factor. In CMS’s specialty impact table, which leaves the conversion factor out, radiation oncology and radiation therapy centers come out +2 percent overall: +4 percent in non-facility settings and -2 percent in facility settings.
Proton gets national rates. Until now 77520 to 77525 were priced by each Medicare contractor. For 2027 they carry national RVUs: 12.74 for 77520 ($415.71) and 34.70 for 77522, 77523 and 77525 ($1,132.26). See proton therapy CPT codes.
OPPS: hospital departments
| Code | 2026 APC | 2026 rate | 2027 APC | 2027 rate | Change |
|---|---|---|---|---|---|
| 77402 | 5621 | 104.24 | 5621 | 130.01 | +24.7% |
| 77407 | 5622 | 394.05 | 5623 | 535.88 | +36.0% |
| 77412 | 5623 | 564.51 | 5623 | 535.88 | -5.1% |
| 77520 proton | 5623 | 564.51 | 5623 | 535.88 | -5.1% |
| 77522, 77523, 77525 proton | 5625 | 1,276.81 | 5625 | 1,465.20 | +14.8% |
| 77301 IMRT plan | 5613 | 1,414.11 | 5613 | 1,557.91 | +10.2% |
| 77373 SBRT delivery | 5626 | 1,826.78 | 5626 | 2,033.48 | +11.3% |
| 77770 to 77772 HDR | 5624 | 711.56 | 5624 | 789.68 | +11.0% |
The ACR asked CMS in its August comment letter to move 77407 into APC 5623, and the final Addendum B does that. Because 77407 is billed far more often than 77412, adding it to APC 5623 lowered the APC’s rate. 77412 now pays the same as 77407 in the hospital, and less than it did in 2026.
Other changes that touch radiation oncology billing
- Modifier 25 visits. An office visit billed on the same day as a 0-day global procedure is paid at 80 percent when it is the lower-paid service. CMS dropped the 10 and 90-day globals and the 50 percent rate it proposed. Radiation oncology codes are mostly XXX, so this matters more to urology and other practices you may bill for. See modifier 25.
- MIPS. Traditional MIPS ends beginning with the CY 2031 performance period, two years later than proposed. Clinicians have through CY 2030 to move to MIPS Value Pathways, and from CY 2027 must report at least one specialty-specific core measure.
- 340B. Hospitals are paid ASP minus 28 percent for 340B-acquired drugs (proposed: minus 33.4 percent). The offset on non-drug payments rises from 0.5 to 2 percent for hospitals subject to it, until the $7.8 billion is recovered, which CMS projects for 2031.
- Site-neutral imaging. Imaging without contrast in excepted off-campus departments is paid at the fee schedule equivalent rate. Radiation therapy is not included.
Worked example: a 20-fraction IMRT prostate course
The same course as in the 2027 proposed rules post, freestanding, non-QP physician: 20 units of 77407 and 77387, 4 units of 77427, and one each of 77263, 77290, 77300, 77301 and 77338.
| 2026 | 2027 final | |
|---|---|---|
| Delivery (20 x 77407) | 6,199.20 | 6,806.60 |
| Image guidance (20 x 77387) | 728.20 | 704.80 |
| Management (4 x 77427) | 781.60 | 747.88 |
| Planning, simulation and devices | 3,112.30 | 2,919.09 |
| Course total | 10,821.30 | 11,178.37 |
The course comes out about 3.3 percent ahead: delivery gains $607.40 and everything else loses $250.33. A hospital department billing the same 20 lines of 77407 under OPPS goes from $7,881.00 to $10,717.60. A course billed mostly as 77412 in the hospital goes down.
What to do now
- Load the final rates, not the proposed ones. Use Addendum B now and the January RVU file when CMS posts it, and rebuild the 2027 expected-payment table from RVUs and $32.63 or $32.95.
- Hospital departments: re-check 77412. Its rate falls to $535.88 while 77407 rises to the same amount. Charge masters, budgets and payer contracts tied to the APC rate should reflect both.
- Proton centers: replace contractor amounts with the national RVUs from January 1, then compare them with what your MAC paid in 2026.
- Count your 2026 courses by delivery level to see how much of the increase applies to you. Iridium Suite’s CodePath holds each course’s planned encounters and codes, so the count comes from plans your team already built.
- Re-read percent-of-Medicare contracts before January. Payers that reprice from the 2027 file will move delivery up and planning down; fixed-year contracts will not.
- Watch Congress for a conversion factor increase before January 1, which would change every number above.
The radiation oncology rule tracker has the proposed and final figures side by side.
Further reading
- CMS fact sheet: CY 2027 Physician Fee Schedule final rule
- CMS press release: CY 2027 Physician Fee Schedule final rule, November 4, 2026
- CMS: CMS-1848-F rule page, with Addendum B and the specialty impact file
- CMS fact sheet: CY 2027 OPPS and ASC final rule (CMS-1850-F)
- CMS: CMS-1850-FC rule page, with the final OPPS addenda
- CMS: PFS relative value files (RVU26D, for the 2026 baseline)