77412 active motion management: what counts, and the documentation payers expect
77412 active motion management means the patient’s motion is tracked during the beam and that tracking controls the beam: it gates it on and off, or adapts it. Positioning before treatment, verification imaging and immobilization alone do not qualify. Many practices have had 77412 denied this year for exactly this distinction, and the fix is mostly in how the note is written.
On July 22, 2026, ASTRO released a model policy for active motion management (AMM) to give payers and practices one shared definition. It is not a payer policy and does not bind any plan, but it is the clearest statement yet of what a reviewer should look for.
Where AMM fits in the 2026 delivery codes
Level 3 delivery (77412) can be met four ways. AMM is the one that turns a single-isocenter course, which would otherwise be 77407, into 77412.
| Level 3 criterion (77412) | Without it |
|---|---|
| Multiple isocenters, photons (2D, 3D or IMRT) | 77407 for a single isocenter |
| Single isocenter, photons, with active motion management | 77407 |
| Total skin electrons | 77402 for electrons |
| Mixed electron and photon fields | 77402 or 77407 |
All three levels include image guidance when performed. The professional component of image guidance is reported separately as 77387-26.
What counts as active motion management, and what does not
ASTRO’s policy sets one test: motion information must actively and continuously influence the beam in real time, so that failing to track would harm the treatment. If the motion data does not change what the beam does, it is not AMM.
| Counts as AMM | Does not count as AMM |
|---|---|
| Respiratory gating, beam on and off with the breathing cycle | Setup or positioning done only before the beam starts |
| Deep inspiration breath hold, when the beam is tied to the breath hold | Verification imaging (IGRT) with no real-time control of the beam |
| Fiducial tracking with triggered imaging during delivery | Immobilization, such as abdominal compression, without motion monitoring |
| Real-time imaging, such as an MR linac | Surface monitoring used only for setup or passive watching |
| Surface guidance that gates or controls the beam | Coughing or arm movement noticed during a static setup |
Surface guidance is the case that causes the most confusion. Under the policy, surface guidance used for positioning or monitoring is image guidance, reported with 77387-26. It becomes AMM only when its motion data gates or controls the beam during treatment.
The policy’s examples of where AMM is usually appropriate are thoracic tumors, upper abdominal tumors, breast cases using breath hold or other AMM for heart and normal tissue sparing (including partial breast and boost), and prostate with continuous fiducial tracking. The treating physician decides case by case.
The five things the note should show
The policy asks for documentation clear enough that a reviewer outside the practice can see both the clinical need and the workflow. eviCore’s guidance to its reviewers asks for the same elements.
- Why this patient needs motion management: the clinical reason, such as heart dose in a left breast case or tumor motion in the lower lung.
- The method and the system: name the system and say whether the beam is gated, adapted, or both.
- The parameters: how motion is monitored, the thresholds and tolerances, and what counts as out of tolerance.
- How motion is watched during treatment: how the data is acquired and reviewed, and how the therapist is alerted.
- Beam control: the beam-on and beam-off criteria, and confirmation that the beam was actually controlled by the motion data.
A short paragraph that covers all five does the job. “DIBH” on its own, or a ticked box, does not.
Worked example
A left-sided whole breast patient is treated with deep inspiration breath hold to keep the heart out of the field. The course is single isocenter.
A note that reads “Treated with DIBH” supports 77407, not 77412: it does not say the beam depended on the breath hold.
A note that reads “Left breast, DIBH for cardiac sparing. Surface guidance system monitors chest wall position continuously during delivery; tolerance 3 mm. The beam holds automatically when the chest wall leaves tolerance and resumes when the patient returns to the breath-hold position; the therapist is alerted on screen” covers all five elements. That course meets the AMM criterion for 77412, subject to the payer’s own policy.
What to do
- Agree a short AMM paragraph with your physicians and physicists, built on the five elements, and use it in the simulation note or treatment summary for every AMM course.
- Code 77412 for a single-isocenter course only when that paragraph is in the record. Without it, code 77407.
- Keep image guidance separate: surface guidance used for setup is 77387-26, not a reason for 77412.
- When 77412 is denied with complete documentation, request a peer-to-peer review and appeal, and cite the model policy.
- Check each payer’s own policy. The model policy does not override a plan’s criteria.
Iridium Suite’s CodePath audits scheduling, delivery, coding and billing against the treatment plan, which catches a 77412 charge on a course whose plan has no motion management recorded.
Related
- The 2026 radiation treatment delivery codes: 77402, 77407, 77412 and 77387
- Image guidance and 77387-26
- Radiation therapy prior authorization requirements by payer
- Radiation oncology claim denials and how to fix them
- Adaptive radiotherapy billing in 2026