CPT code 77407 – Level 2 radiation treatment delivery

Key takeaways

CPT code 77407 is Level 2 radiation treatment delivery in the 2026 CPT code set, reported once per treatment session.

Level 2 covers single-isocenter 3D conformal or IMRT photon treatments. Multiple isocenters or motion-managed photon therapy move the session up to 77412.

The pre-2026 intermediate criteria no longer apply. Treatment area counts, mixed energies and blocks do not select the code, and IMRT no longer defaults to 77412.

Imaging guidance is included in 77407. According to ASTRO, only the physician’s image review is reported separately, with 77387 and modifier 26.

CPT 77385, 77386, 77014 and HCPCS G6001 to G6017 were deleted on January 1, 2026, so none of them belongs on a 77407 claim.

Pabau’s claims management software helps radiation oncology teams flag missing documentation and code conflicts before a claim is submitted.

What is CPT code 77407? Level 2 radiation treatment delivery

CPT code 77407 is Level 2 radiation treatment delivery, the middle of the three external beam delivery levels in the 2026 CPT code set. It reports the delivery itself, once per treatment session.

Sanford Health Plan summarizes the revised code as Level 2 radiation delivery, such as single-isocenter 3D or IMRT photon treatments, including imaging guidance. The American Medical Association (AMA) maintains the full descriptor in the CPT code set.

• Code: 77407
• Section: Radiation oncology, radiation treatment delivery
• Level: Level 2 of 3, effective January 1, 2026
• Typical technique: 3D conformal or IMRT photon therapy to a single isocenter
• Reported: Once per treatment session (fraction)
• Setting: The same three levels apply in hospital outpatient departments and freestanding centers

Each session carries one line of 77407. A 25-fraction course therefore produces 25 units of 77407, one for each session delivered.

What CPT 77407 covers and what it does not

CPT 77407 covers the physical delivery of a Level 2 treatment session. That includes patient setup, beam delivery, and the imaging guidance performed to position the patient for that fraction.

The following services sit outside 77407 and are reported with their own codes when performed:

• Treatment planning (77261-77263): The physician treatment plan is billed once per course, not per fraction.
• IMRT planning (77301): IMRT planning is upstream of delivery and separately billable. The 2026 delivery itself goes on 77402, 77407 or 77412, by delivery technique.
• Simulation (77280-77290): Field setting and simulation are pre-treatment services.
• Basic dosimetry (77300): Physics calculations are billed separately from delivery.
• Physician image review (77387-26): The technical side of image guidance is bundled into 77407. The physician review is covered in the 77387 section below.
• Radiation treatment management (77427): Physician management, reported per five fractions, is covered in the 77427 section below.

Understanding radiation oncology billing in 2026 means tracking what the delivery levels now absorb. Payer edits and NCCI tables are still settling after the restructure, so check them each quarter.

CPT 77407 vs 77402 vs 77412: Choosing the correct level

The three delivery codes are now graded by delivery technique, not by treatment areas, beam energies or blocks. All three include imaging guidance, and a session is reported at one level only.

Under the pre-2026 rules, IMRT delivery usually went to 77385 or 77386, or to 77412 as complex delivery. Those IMRT delivery codes are now deleted. A single-isocenter IMRT plan without active motion management reports as 77407.

ASTRO describes Level 2 as a broad category. It now captures many common sites that were billed with the deleted IMRT codes, including prostate, head and neck, rectum and brain.

Work up the ladder when you pick the code. Confirm the technique and isocenter count first, then check whether motion management controlled the beam. Several beams around one isocenter still count as a single isocenter.

What changed for CPT code 77407 in 2026

CPT code 77407 kept its number on January 1, 2026 and received a new, technique-based descriptor. The old “intermediate” label is gone, along with its criteria of two or three treatment areas, mixed energies and standard blocks.

Several related codes were deleted at the same time:

• IMRT delivery codes: 77385 and 77386 were deleted. Sanford Health Plan notes that their work is now included in 77407.
• CT guidance: 77014 was deleted and bundled into the daily delivery codes.
• Radiation treatment delivery G-codes: G6001 through G6017 were deleted.

Some payers are carrying authorizations across the change. Sanford Health Plan, for example, honors existing authorizations for the revised codes and maps those for retired codes to the new ones.

Can CPT 77407 and 77387 be billed together?

Only the professional component of 77387, according to ASTRO. From January 1, 2026, the technical side of image guidance is bundled into the delivery codes, including 77407.

ASTRO describes 77387 as a professional-only code for 2026. The physician review of the guidance images is therefore reported on a 77387 line with modifier 26, alongside the 77407 delivery line.

• Delivery line: 77407, once per session, with image guidance included.
• Physician review: 77387 with modifier 26, when the physician reviews the guidance images.
• Deleted guidance codes: 77014 and the image guidance G-codes no longer exist, so they cannot be added to a 77407 session.
• Payer policy: Commercial payers adopted the changes on their own timelines. Confirm each payer’s current radiation oncology policy before the first 2026 claim.

Radiation treatment management: Billing CPT 77427 alongside 77407

CPT 77427 covers physician radiation treatment management and is reported once per five treatment sessions (fractions). It is billed alongside the 77407 delivery lines and reflects the physician’s oversight of treatment response, setup and the plan.

The count follows fractions delivered, not calendar months or billing periods. Common billing errors when pairing 77427 with 77407:

• Billing 77427 before five fractions are complete: Each unit needs five delivered fractions. The exception is the end of a course, where three or four fractions beyond a multiple of five support one more unit. One or two do not. A unit billed at fraction three will deny.
• Tying the count to the calendar: A course that crosses a month boundary keeps counting from the last unit. The five-fraction count does not reset on the first of the month.
• Thin physician documentation: The physician must document a patient encounter or chart review covering treatment response, side effects and plan changes. Delegating the note to a therapist without physician sign-off is a denial risk.
• Missing the final unit: A 23-fraction course bills four units for fractions 1-20 and one more for fractions 21-23. Stopping at four leaves a billable unit unclaimed.

Documentation requirements for CPT 77407

Each session billed under 77407 needs a treatment record that supports Level 2. Auditors now look for technique and isocenter evidence, not beam counts or energy mixes.

For billing compliance documentation, the record for each 77407 session should include:

• Signed treatment order: A dated physician order naming the treatment site, prescribed dose, fractionation and intent.
• Treatment technique: The plan should show 3D conformal or IMRT photon therapy, which separates Level 2 from 2D or simple electron work at Level 1.
• Isocenter count: The plan should show a single isocenter. A second isocenter for a separate treatment volume points to 77412.
• Motion management status: Record whether active motion management controlled the beam. If it did, the session belongs on 77412.
• Daily treatment record: Monitor units, field arrangement and patient positioning for the fraction billed, plus the therapist’s setup and tolerance note.
• Image guidance record: The imaging modality and the physician’s review, which supports a 77387-26 line.

Practices that use clean claim submission workflows build these elements into the treatment record template. Every fraction then carries the evidence auditors need before the claim goes out.

Prior authorization requirements for CPT 77407

Many commercial payers require prior authorization for radiation delivery codes, including 77407. Treating without it is one of the most avoidable causes of a full claim denial in radiation oncology.

Confirm insurance eligibility verification and authorization status before the patient’s first fraction. Key payer pathways:

• eviCore Healthcare: eviCore manages radiation oncology prior authorization for several national and regional plans. Requests usually need the treatment plan, diagnosis, fractionation and supporting documentation, and approvals are often issued by CPT code.
• Molina Healthcare: Molina requires prior authorization for radiation oncology services. Check its current radiation therapy code list after the 2026 changes.
• Medicare/CMS: Traditional Medicare does not require prior authorization for 77407. Medicare Advantage plans may set their own rules, so verify the specific plan.
• Authorizations issued before 2026: Some payers map approvals for retired codes such as 77385 to the revised codes. Confirm how each payer handled the change before billing.

When authorization is granted, keep the authorization number with the claim. Some payers require it in field 23 of the CMS-1500 form.

Medicare reimbursement rate for CPT 77407

Medicare pays 77407 under two systems, depending on where the treatment is delivered. Freestanding radiation oncology centers are paid under the Medicare Physician Fee Schedule (MPFS), and hospital outpatient departments under the Outpatient Prospective Payment System (OPPS).

MPFS rates are built from relative value units and adjusted by the Geographic Practice Cost Index (GPCI) for each locality. Check the current national and locality rates for 77407 in the CMS Physician Fee Schedule lookup tool. Rates update each January 1.

Payment for 77407 changed shape in 2026 as well as value. IMRT work that was paid under 77385 and 77386 now sits inside the Level 2 rate. The technical side of image guidance is bundled in too. Compare your 2026 remittances against the 2026 fee schedule, not your 2025 mix of delivery and guidance lines.

Why CPT 77407 claims get denied and how to avoid it

Denials on 77407 in 2026 cluster around the transition to the new levels. Each pattern below has a fix that billing coordinators can apply before the claim leaves the practice.

• Missing prior authorization: Authorization must be in place before treatment begins. Use claims management software to flag cases pending authorization before the first fraction is scheduled.
• Choosing the level by the old criteria: Counting treatment areas or energies leads to the wrong code. Pick the level from technique, isocenter count and motion management instead.
• Billing the wrong level: A 2D or simple electron session billed as 77407 is overcoded. A motion-managed or multi-isocenter session billed as 77407 leaves money unclaimed, because it qualifies for 77412.
• Reporting deleted codes: 77385, 77386, 77014 and G6001 to G6017 were deleted on January 1, 2026. Any of them on a 2026 claim will reject.
• Billing 77387 without modifier 26: ASTRO describes the technical component as bundled into the delivery codes. Report only the physician review, as 77387-26.
• Duplicate billing on one date: 77407 is one line per session. A second session on the same date needs documented twice-daily treatment and the payer’s repeat-procedure modifier.
• Thin treatment records: A record that says only “treatment delivered” gives the payer grounds to deny. Use electronic claims via Claim.MD to check claim data against the record before submission.

Systematic denial management workflows that track 77407 denial reasons by payer show whether a pattern is isolated or systemic. That tells the team whether to fix documentation or appeal at the payer level.

How Pabau supports radiation oncology billing

A radiation oncology course produces several parallel claim lines. The delivery level goes on each session, 77387-26 follows each physician image review, and 77427 follows every five fractions.

Keeping those lines in step across a six-week course is hard to do from memory, especially in the first year of new codes. Pabau, the practice management platform we build, links the treatment record to claim generation so the companion lines travel with the delivery code.

Billing teams can build CPT bundles for a treatment course, flag code conflicts before submission, and send claims through Claim.MD. Remittance comes back as ERA files, so each payment can be checked against what the session should have paid.

Streamline your radiation oncology billing

Pabau’s claims management tools help radiation oncology practices track authorization status and flag missing documentation. Claims for codes like CPT 77407 go out cleaner, before denials happen.

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Conclusion

CPT code 77407 now means Level 2 radiation treatment delivery, chosen by technique rather than by treatment areas or energies. For most single-isocenter 3D and IMRT courses, it is the code that carries the delivery.

Claims built on the old framework are where 2026 denials concentrate. Clear the deleted codes out of your charge lists, send image review as 77387-26, and count 77427 by fractions rather than months.

Pabau helps radiation oncology billing teams keep the delivery level, the guidance line and the management units together from record to claim. To see that workflow on a full treatment course, book a demo.

Continue your research

Need to understand how claims move through the clearinghouse? Understanding medical claims clearinghouses explains the end-to-end submission and adjudication process for radiation oncology and other specialty claims.

Seeing ERA discrepancies on your 77407 remittances? Electronic remittance advice covers how to read ERA files, interpret CARC denial codes, and match payments to submitted claims.

Want to reduce revenue cycle errors across your practice? Revenue cycle management fundamentals walks through the full billing workflow from eligibility verification to payment posting.

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