04/09/2026

What Radiation Oncology Practices Need to Know About 2026 Coding and Reimbursement Changes

The 2026 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System final rules introduced a major overhaul of radiation treatment delivery and image guidance codes. Implementation of these codes has created unforeseen administrative and financial concerns for radiation oncology practices across the United States. A summary of the situation is outlined below.

2026 Coding Updates

Effective January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) implemented a major consolidation of and update to radiation treatment delivery CPT codes, including:

• New Delivery Hierarchy: All external beam treatment delivery codes have been consolidated into three revised tiers by level of complexity: 77402 (Level 1), 77407 (Level 2), and 77412 (Level 3).
• A Shift in Valuation: These new codes no longer distinguish strictly between 3D and IMRT; instead, they focus on the complexity of the delivery itself, such as the use of multiple isocenters or active motion management.
• Bundled Image Guidance: The technical component of image guidance is now bundled into the new delivery codes rather than being billed separately.
• Professional Services: The professional component of radiation therapy image guidance services has been consolidated into a single code, 77387.
• Code Deletions: CPT codes 77385, 77386, 77014, and HCPCS codes G6001-G6017 have been deleted.
• Revalued RVUs: Recognizing that these bundled codes are more resource-intensive, CMS updated the Relative Value Units (RVUs) to reflect modern clinical practice and specialized infrastructure.