CPT Code 77014: CT guidance for radiation therapy fields

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Key takeaways

CPT code 77014 was deleted effective January 1, 2026, and claims with a later date of service must use its replacement path.

The technical component of CT guidance is now bundled into the revised treatment delivery codes 77402, 77407 and 77412.

The professional component is reported with 77387 and modifier 26, so 77387 replaces only half of what 77014 used to cover.

Medicare no longer prices 77014, so payment follows the delivery level billed plus the 77387-26 professional read.

Claim.MD integration with Pabau flags unrecognized codes on remittance, which catches a stray 77014 before it repeats across a treatment course.

CPT code 77014 described computed tomography guidance for the placement of radiation therapy fields, and it was deleted effective January 1, 2026. Nothing replaces it one-for-one.

The technical component of that CT guidance now sits inside the revised treatment delivery codes 77402, 77407 and 77412, which include imaging guidance when performed. The physician read is billed separately as 77387 with modifier 26.

Each component now travels on a different line of the claim, which is where crosswalk errors begin. This reference covers the deletion, the crosswalk on both components, and the modifiers that still matter. It also sets out documentation and the denial patterns that follow a retired code.

What was CPT code 77014?

CPT code 77014 was the American Medical Association code for computed tomography guidance for placement of radiation therapy fields. The radiation oncologist or medical physicist used CT imaging at the treatment unit to confirm that the planned fields lined up with the target volume.

The code captured that localization service separately from the radiation delivery itself. As of January 1, 2026 it no longer exists.

The service did not disappear with the code. CT guidance is still performed, still documented, and still paid. What changed is where it is reported. The 2026 CPT revision moved the equipment and staff work into the delivery codes and left the physician interpretation as a standalone professional service.

Code status note: the AAPC CPT code database lists 77014 among the deleted codes. The CY2026 Medicare Physician Fee Schedule and Hospital Outpatient final rules carry the same deletion. A claim that still contains 77014 for a 2026 date of service is rejected, not reduced.

What replaced CPT code 77014 in 2026?

Two codes replaced 77014, not one. The AMA revised the external beam delivery family into three complexity levels and folded image guidance into them.

The technical component now travels with the delivery code. Image guidance for all treatment delivery was then consolidated into 77387, which survives as a professional-only service reported with modifier 26. The split below is the shape to hold in mind before reading the crosswalk table.

Read the crosswalk in that order and the billing follows. Pick the delivery level that matches what was actually delivered, then add 77387-26 for the physician read.

Do not append TC to 77387, and do not look for a separate guidance line item on the technical side. The equipment and staff work is already paid inside 77402, 77407 or 77412.

Medicare reimbursement after the 77014 deletion

Medicare no longer prices CPT code 77014, because a deleted code carries no fee schedule amount. Payment for the same clinical work now arrives in two pieces. The technical side is paid through the delivery code, and the professional side is paid through 77387-26.

Rates for both still come from the CMS Medicare Physician Fee Schedule (MPFS) and vary by locality. Hospital outpatient departments are paid under OPPS instead. Because the delivery codes were revised and revalued for 2026, last year’s figures are not a usable reference point.

Commercial allowables still vary by contract, and some payers apply local coverage policies that differ from Medicare. Checking the payer-specific fee schedule before a treatment course starts is the safest way to avoid a revenue surprise across twenty or thirty fractions.

Applicable modifiers

Modifiers no longer attach to 77014, because the code cannot be submitted. They attach to the codes that replaced it. Modifier 26 is the important one. Code 77387 is reported as a professional service, and the technical component of image guidance sits inside the delivery code.

Medicare prefers the X modifiers (XE, XS, XP, XU) over modifier 59 when two services need to be distinguished. Check with your MAC before defaulting to 59 on a radiation oncology claim. Bundling edits between 77387 and the delivery codes are tighter than they were under the old structure.

Documentation requirements for CT guidance

Bundling changed the billing, not the chart. Payers still require contemporaneous documentation to support the guidance service. An incomplete record is the most common reason a radiation oncology imaging claim is denied. Following ASTRO’s coding guidance for CT guidance, the medical record should include:

• A physician order specifying CT guidance for field placement, distinct from the treatment order
• CT images with date and time stamps confirming acquisition on the date of service
• A written interpretation from the responsible physician, documenting the findings and their effect on field placement
• The treatment plan or setup sheet showing the fields that were confirmed or adjusted
• Patient identity verification linking the imaging session to the specific treatment fraction

The written interpretation carries more weight than it used to. It is the evidence behind the 77387-26 line, and a missing report now costs the only separately payable piece of the service. Before submission, match the imaging date on the CT report to the date of service on the claim. A mismatch alone can trigger a medical review request.

Medical necessity criteria

Medicare and commercial payers cover image guidance when it is medically necessary for accurate field placement. The relevant local coverage determination, L34652 in many jurisdictions, sets out the clinical indications. Coverage generally requires:

• A confirmed malignancy or other condition requiring external beam radiation therapy
• A treatment plan specifying the need for CT-based localization at the treatment unit
• The treating physician’s documented judgment that image guidance is required for field accuracy
• An ICD-10-CM diagnosis code consistent with the covered diagnosis list in the applicable LCD

Payers do not assume guidance is warranted on every fraction. Some LCDs limit frequency, covering the initial field setup plus later sessions where a field modification is documented.

Reporting 77387-26 on every daily fraction without a clinical reason can still trigger a recoupment audit, even though the technical component is bundled. Find your MAC and its applicable LCD through the CMS Medicare Coverage Database.

Common billing errors and denial reasons

Radiation oncology billing produces a concentrated set of denial patterns, and the 2026 restructure added a few. Most of them come from the same handful of mistakes.

• Submitting the deleted code: 77014 on a 2026 date of service is rejected outright. Remove it from the charge master, the EHR charge capture screen, and any saved claim template, not just from the billing team’s memory.
• Billing 77387 without modifier 26: a global 77387 asks for a technical component that is already inside the delivery code. Expect a bundling denial or a reduction.
• Looking for a separate technical guidance line: teams that used to bill 77014-TC sometimes replace it with 77387-TC. There is no separate technical payment for image guidance in 2026.
• Choosing the wrong delivery level: 77402, 77407 and 77412 are Levels 1, 2 and 3. Picking a level from habit rather than from the treatment record creates both underpayment and audit exposure.
• Mismatched diagnosis codes: an ICD-10-CM code not listed in the LCD’s covered diagnoses produces a non-covered-service denial. Cross-check against the LCD before submission.
• Frequency excess: reporting guidance on every daily fraction without a documented clinical reason violates most LCDs. Record the reason each time guidance is used beyond the initial setup.

Tracking denial codes at the CPT-code level exposes these patterns before they compound across a course. The diagnosis side deserves the same scrutiny, so check each claim against the ICD-10-CM diagnosis codes the applicable LCD covers. CARC codes returned on the remittance then point at the line that failed.

Related CPT codes in radiation oncology

CPT code 77014 sat within a family of radiation oncology codes, and its work is now spread across several of them. The table below shows the companion codes a coder meets on a radiation therapy claim, and how each one relates to the guidance service.

The audit-sensitive distinction is now between the delivery level and the professional read. Confirm which delivery level was actually performed, then confirm that a physician interpretation exists before 77387-26 goes on the claim. Simulation codes 77280 to 77295 remain separate from both.

How Pabau handles radiation oncology claims after the 77014 deletion

A code deletion hits radiation oncology harder than most specialties. Claims are high in volume and repetitive, so one wrong code repeats across every fraction in a treatment course. By the time a quarterly review finds it, the practice is rebilling weeks of work.

Practice management software like Pabau keeps that loop short. Pabau’s claims software for oncology practices, integrated with Claim.MD, submits claims electronically to thousands of US payers. T

he integration handles CMS-1500 and 837P claims, returns eligibility results while the claim is being prepared, and posts ERA remittances with CARC denial codes.

For a practice that used to bill 77014 alongside 77427 and 77336, that visibility is what surfaces the crosswalk error early. A rejection for an unrecognized code shows up on the remittance within days. The billing team can fix the charge template before the pattern spreads across the rest of the course.

The wider benefit is catching a retired code at the first remittance rather than at the next audit. Practices can also export superbills through the Claim.MD integration, then reconcile treatment session records against claim submissions each day.

Reduce radiation oncology claim denials

Pabau’s claims management tools, integrated with Claim.MD, automate eligibility verification, code validation, and ERA posting for radiation oncology practices. See how it works for your billing workflow.

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Conclusion

CPT code 77014 is gone, deleted effective January 1, 2026, and the service it described is now billed in two places. The technical component rides inside the delivery code, 77402, 77407 or 77412.

The professional component is reported as 77387-26. A billing team that carries only half of that crosswalk will either lose the physician read or chase a technical payment that no longer exists.

From there the recurring work is familiar: complete documentation, accurate modifiers, and payer-specific frequency limits.

Pabau’s integration with Claim.MD gives radiation oncology practices eligibility checks and denial-code visibility. That is what keeps a coding change from turning into a month of rework. Book a demo to see how the workflow fits your billing setup.

Continue your research

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Want to verify claim accuracy before submission? Medical billing compliance covers the key rules that keep radiation oncology claims audit-ready.

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