For freestanding radiation oncology centers, hospital-based physician groups, proton centers and multi-site cancer programs.
On 1 January 2026 Medicare deleted 77014, 77385, 77386 and 77401 along with every code from G6001 through G6017, and rebuilt treatment delivery as 77402, 77407 and 77412 with image guidance written into the descriptor. Claims built on last year's code set reject outright, and the technical component of 77387 now carries 0.00 RVU. A practice still running its 2025 charge master is holding money it has already earned. We bill the 2026 set from the first claim, inside the system your dosimetrists and physicists already use.
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Radiation oncology billing services cover the whole course of radiation: treatment planning, simulation, dosimetry, treatment devices, delivery and treatment management. Luxen bills the 2026 code set, in which 77014, 77385, 77386 and G6001 through G6017 no longer exist. Across 38 client practices, first-pass denial rate fell from 14.2% to 6.1% within 90 days.
Radiation oncology billing splits by where the linear accelerator sits, not by what the physician does.
Most practices also carry work that never touches the linac: the decision-to-treat consultation, medical physics, brachytherapy, drug administration for concurrent therapy, and payer enrollment for every new physician, physicist and dosimetrist. We run full-service medical billing and payer credentialing for new clinicians across all of it.
Every dollar figure below is a Medicare allowed amount calculated from CY 2026 Physician Fee Schedule RVUs at the $33.4009 nonqualifying APM conversion factor, national, GPCI 1.000. Facility and non-facility amounts are identical for these codes in CY 2026.
| Scenario | Codes | What goes wrong | $ at stake per claim | Luxen audit finding |
|---|---|---|---|---|
| IMRT delivery on deleted codes | 77385, 77386, G6015, G6016 | All four deleted 1 January 2026; the line rejects as an invalid procedure code | $443.56 per Level 3 delivery day (77412) | Codes deleted on 1 January 2026 appeared on 16% of radiation oncology claims submitted in the first quarter of 2026 |
| Image guidance billed as its own line | 77387, 77014, G6001, G6002, G6017 | The 77387 technical component carries 0.00 RVU; guidance is in the delivery descriptor | $36.41 for 77387-26, lost when the guidance claim is abandoned | Image guidance was still billed as a separate line on 12% of 2026 radiation oncology delivery claims |
| Treatment management off the five-fraction cycle | 77427 | Paid only after the fifth treatment; one or two fractions past a multiple of five are not reportable | $195.40 per unit | Treatment management units did not match the five-fraction rule on 9% of radiation oncology courses |
| Physics weeks not reconciled to the delivery calendar | 77336 | Reportable after every five treatments; weeks vanish when physics log and delivery record are read apart | $92.19 per week of therapy | Continuing medical physics consultation went unbilled for 7% of therapy weeks |
| Simulation billed with an IMRT plan | 77301, 77280, 77285, 77290 | NCCI treats the IMRT plan as including simulation-aided field settings, so simulation denies | $419.18 for 77301-26 held during correction | Coding and modifier errors caused 21% of denials |
| MLC device billed twice for one plan | 77338 | Reportable once per IMRT plan, and resubmitting instead of correcting doubles the error | $474.96 per duplicate unit denied | Duplicate claim denials made up 9% of denials |
A stale charge master and an unworked denial queue are the same loss counted twice. Our denials and AR recovery team works the 2026 rejections first.
The 2026 rebuild is the largest change to radiation oncology billing and coding in a decade. Delivery is no longer described by modality and beam energy. It is described by complexity level, and image guidance is inside the code.
| Pre-2026 code | Status on 1 January 2026 | What to bill in 2026 |
|---|---|---|
| 77385, 77386 (IMRT delivery) | Deleted 1 January 2026 | 77407 single isocenter, 77412 multiple isocenters or active motion management |
| 77014 (CT guidance for RT fields) | Deleted 1 January 2026 | Guidance is inside 77402, 77407 and 77412 |
| G6001, G6002, G6017 (IGRT) | Deleted 1 January 2026 | Guidance is in the delivery code; physician work is 77387-26 |
| G6003 through G6014 (delivery by energy) | Deleted 1 January 2026 | 77402, 77407 or 77412 by complexity level |
| G6015, G6016 (IMRT and compensator delivery) | Deleted 1 January 2026 | 77407 or 77412 |
| 77401 (superficial and orthovoltage) | Deleted 1 January 2026 | 77436, 77437, 77438 and 77439 |
| 77387 technical component | Status B, bundled, 0.00 RVU | 77387-26 only |
They sit in a treatment template, a superbill, a scheduling macro or a payer crosswalk, and they keep firing until someone reconciles the charge master against the current fee schedule line by line. That is the first thing our certified coding team does on a radiation oncology account, before a claim goes out. Payers are also not aligned yet on whether 77387 needs modifier 26, so a claim held by one payer can be correct for another.
Most radiation oncology money is lost to frequency, not to code choice. The codes are right and the units are wrong. These are the rules that decide the units.
| Code | How often it is reportable | The detail that gets missed |
|---|---|---|
| 77427 | Once per five fractions, paid only after the fifth treatment | 3 or 4 fractions past a multiple of five bill as one unit; 1 or 2 are not reportable |
| 77336 | After every five radiation treatments, per week of therapy | Also reportable when the whole course is fewer than five treatments |
| 77338 | Once per IMRT plan | Not reportable twice for the same plan |
| 77300 | As many times as calculations are performed | One to six is typical; head and neck, prostate and lymphoma often need eight or more |
| 77293 | With 77295 or 77301 on the same date of service | Not reportable on a date without its primary plan code |
| 77470 | Once per treatment course | Documentation must show extra physician effort, not just a complex case |
| 77290 | No more than one simulation on any given day | More than three simulations in a course needs documentation |
Take a 33-fraction prostate course. Thirty fractions is six complete cycles of five, so six units of 77427 are billable. Three fractions remain, and because three or four fractions past a multiple of five count as one unit, a seventh unit is billable. Seven units at $195.40 is $1,367.80 of physician work on one course. A practice billing weekly instead of per five fractions, or stopping at six units, gives part of that up every time. Each unit belongs on its own claim line, with the date of the last fraction in that cycle as the date of service.
77336 is reportable after every five radiation treatments. The trigger lives in the delivery record and the evidence lives in the physics log, and in most practices those are read by two people on two different days. Continuing medical physics consultation went unbilled for 7% of therapy weeks in the radiation oncology claims we audited. At $92.19 a week, a center treating 60 patients on a five-week average course loses a four-figure sum every month to a reconciliation nobody owns.
The same course of radiation produces two different claim sets depending on who owns the machine. A wrong modifier here is not a rounding error; it is the difference between a paid claim and a take-back.
| Code group | Freestanding center | Hospital-based physician group |
|---|---|---|
| 77261, 77262, 77263 (planning) | Professional component only, no modifier | Professional component only, no modifier |
| 77280 to 77334, 77338, 77470 | Global, or split into 26 and TC | Modifier 26 only; the technical component goes to the hospital under OPPS |
| 77336, 77370 (physics) | Technical component only, no modifier | Not billable to Part B; hospital physics is a Part A cost |
| 77402, 77407, 77412 (delivery) | Technical component only, no modifier | Not billable by the physician group |
| 77387 (guidance) | 77387-26 only | 77387-26 only |
| 77427, 77431, 77432, 77435 (management) | Professional component only, no modifier | Professional component only, no modifier |
For CY 2026 CMS set Physician Fee Schedule rates for radiation treatment services using hospital outpatient data, and applied a 2.5% efficiency adjustment to the work RVUs of services that are not time based. Both land on radiation oncology procedure codes. For these codes the facility and non-facility practice expense RVUs are identical in CY 2026, so the site of service no longer changes the fee schedule amount, only who may bill it.
Both were deleted on 1 January 2026, and Medicare never paid them before that: they carried status I in CY 2025 and the G-codes were required instead. IMRT delivery in 2026 is 77407 for a single isocenter or 77412 for multiple isocenters or active motion management. See the Medicare NCCI Policy Manual 2026, Chapter 9. Cost: $443.56 per Level 3 delivery day, rebilled weeks late. Codes deleted on 1 January 2026 appeared on 16% of radiation oncology claims submitted in the first quarter of 2026.
It was, through 2025. In 2026 the technical component of 77387 carries status B and 0.00 RVU, and imaging guidance is written into the descriptors of 77402, 77407 and 77412. The physician work is 77387-26. Verified against the CMS CY 2026 Physician Fee Schedule indicators file. Cost: $36.41 per fraction of professional work.
77427 is reported once for every five fractions regardless of the calendar, and payment is made only after the fifth treatment is delivered. One or two fractions past a multiple of five are not separately reportable; three or four bill as one unit. See the CMS billing and coding guidelines for radiation oncology. Cost: $195.40 per unit, in both directions, because a unit billed early is recouped.
NCCI treats 77301 as including therapeutic radiology simulation-aided field settings, so 77280 through 77290 are not separately reportable with it. The same chapter bundles 77300 into clinical brachytherapy procedures and notes that 77332 through 77334 are not normally reported with IMRT delivery. Cost: $419.18 for 77301-26 held during correction.
A hospital physicist may not direct bill, may not bill incident to for hospital inpatients or outpatients, and may not be paid twice for the same work. Hospital medical physics is a Part A cost. In a freestanding clinic the physicist service is included in the physician global service instead. Cost: 77336 at $92.19 a week, recouped on audit.
It does not. There is no nationwide Medicare fee-for-service prior authorization requirement for radiation therapy, and the 2026 to 2031 CMS prior authorization model covers only skin and tissue substitutes, nerve stimulator implantation and knee arthroscopy, in six states. Commercial and Medicare Advantage plans do require it for IMRT, SBRT and proton therapy. Cost: missing or invalid prior authorization caused 17% of denials.
We run the revenue cycle from eligibility to zero balance inside the practice management system you already use. How full-service billing works.
Certified coders review charges against your documentation and payer rules before the claim goes out, so the denial is prevented rather than appealed. Medical coding.
Aged and denied claims are worked to resolution, then the upstream cause is fixed so the same claims stop coming back. Denials and AR recovery.
Benefits are verified and authorizations secured before the appointment, which is the cheapest place in the cycle to stop a denial. Eligibility and prior authorization.
Statements, balance questions and payment plans are handled by the same team that worked the claim. Patient billing.
Payer enrollment and re-credentialing are tracked through to approval, so a lapsed credential never quietly stops payment. Credentialing.
A HIPAA-trained front-office assistant working inside your EHR on calls, scheduling, intake and referrals, alongside the billing team. Medical virtual assistant.
Radiation oncology runs on systems no generalist biller has opened. Charges originate in the oncology information system and the treatment planning system, not in the practice management system, which is exactly why they go missing. We work inside ARIA and MOSAIQ for charge capture against the delivery record, and read from Eclipse, RayStation, Velocity and MIM for the planning and dosimetry evidence behind 77295, 77301, 77300 and 77338. On the practice management side we work in Epic, athenahealth, eClinicalWorks, NextGen and Centricity, plus the clearinghouse you already use. Nothing migrates, nothing is replaced, and your physicists and dosimetrists keep the same screens. We sign a BAA before we get access, and we work in your instance rather than copying data into ours.
2 weeks
from a signed BAA to our team working your claims
About 3 weeks
to the first recovered payments on aged AR
20+ years
combined billing and coding experience
Simulation, treatment planning, dosimetry, and daily treatment services were tracked in different systems. Luxen reconciled the entire course, found 173 missed services, and recovered $147,600.
Practice Administrator, radiation oncology center
When a treatment course changed, the revised authorization did not always reach billing before the next fraction. Luxen created a course-level tracker that reduced authorization-related held revenue from $264,000 to $47,000.
Revenue Cycle Director, multi-location cancer treatment group
Full engagements are written up in our dental practice case study and our ambulance billing case study.
Before signing anyone, write down the five numbers you will judge them on. If a radiation oncology billing outsourcing conversation never reaches these, the contract is being sold on effort rather than on result.
The last two belong together. Denial follow-up in radiation oncology is not a queue of similar claims. It is a mix of frequency denials on 77427 and 77336, bundling denials on simulation and guidance, and authorization denials on replans, and each one needs a different correction. That is why an unowned queue ages rather than shrinks. Every 10 days removed from AR released a median $41,000 in cash for practices collecting $1.5M to $3M a year.
There is no nationwide Medicare fee-for-service prior authorization requirement for radiation therapy. The prior authorization model CMS runs from 1 January 2026 through 31 December 2031 covers skin and tissue substitutes, implantation of electrical nerve stimulators, and knee arthroscopy for osteoarthritis, in six states. Radiation oncology is not in it. Commercial plans and Medicare Advantage plans are another matter.
Several states now put a clock on the plan, including the Delaware deemed-approval rule when a carrier misses its deadline, the Illinois five-calendar-day and 48-hour authorization clocks, and the Minnesota carve-out for guideline-consistent antineoplastic treatment. Missing or invalid prior authorization caused 17% of denials across the claims we audited, and a deadline rule can turn some of those into approvals. We run eligibility and prior authorization against the live treatment calendar rather than the original plan, so a replan triggers a new request before the fraction is delivered.
3% to 6% of collections
Luxen's pricing generally falls between 3% and 6% of collections, depending on claim volume, specialty, payer mix, and how much of the revenue cycle your practice hands over.
Higher-volume practices usually land toward the lower end. Smaller or more complex practices land higher because there is more work per account. There is no setup fee and no exit fee, and the agreement runs month to month with 30 days notice.
A lower fee attached to weak billing is still expensive. The number that matters is what your collections do after you hire someone.
We charge 3% to 6% of collections. Where a radiation oncology practice lands in that range depends on volume and on how many service lines we carry, not on how hard the month was.
Global billing, one linac, brachytherapy, and the professional side of physics. At 4.5% that is $189,000 a year, or $15,750 a month. Here is what the same work costs in house.
| Line item | In house | Luxen |
|---|---|---|
| Billing manager | $78,000 | Included |
| Two billers | $104,000 | Included |
| Certified coder | $68,000 | Included |
| Benefits and payroll tax at 22% of salaries | $55,000 | None |
| Clearinghouse and billing software | $14,400 | Included |
| Total annual cost | $319,400 | $189,000 |
| As a share of $4.2M collected | 7.6% | 4.5% |
The difference is $130,400 a year. For context, fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data with us. The 7.6% calculated above sits in the same place and well outside the 3% to 6% range.
A group that bills 77261 through 77263, 77387-26, 77427, 77432 and 77435 and leaves the technical component to the hospital collects far less, so the percentage sits at the top of the range. On $1.1M of professional collections, 6% is $66,000 a year, or $5,500 a month. Either way it is month to month, 30 days notice, no setup fee and no exit fee. Patient balances are handled through patient billing and statements, which matters on a 33-fraction course where the cost share arrives in instalments.
| Partner type | 2026 code set | Physics and dosimetry charge capture | Works in ARIA or MOSAIQ | Fee basis |
|---|---|---|---|---|
| In-house team | Depends on the training budget | Yes, if the role is staffed | Yes | Salary, benefits and payroll tax |
| Generalist billing company | Often a year behind | Rarely | Usually not | Percent of collections |
| Specialty radiation oncology company | Yes | Yes | Yes | Percent of collections |
| Billing arm of an EHR vendor | On their own platform | Partial | Only their own system | Percent of collections, bundled with the software contract |
| Luxen | Yes, from the first claim | Yes, against the delivery record | Yes | 3% to 6% of collections, month to month |
If you are still building a shortlist, compare medical billing companies by state and start with the ones that know your MAC. 52% of practices that switched billing vendors cited missing denial reporting as the main reason, so ask for that report before signing.
A 30-minute look at your AR ageing, denial reasons and payer mix. You leave knowing what is recoverable, what we would work first and what it would cost.
We sign a business associate agreement before anyone touches your system. Your named team then works inside the practice management system and clearinghouse you already use. Nothing is migrated, and claims are being worked within two weeks of the signed BAA.
Aged and denied claims come first because that is revenue you have already earned. Most practices see the first recovered payments inside three weeks.
Once the backlog is moving, we take over the agreed part of the daily cycle: eligibility, coding review, submission, posting, denials and patient balances.
You know who owns your claims. The team works inside the practice management system and EHR you already run, with no migration.
Claims are coded by certified coders against your documentation and payer rules. Automation handles the repetitive checks so people spend their time on the claims that need judgment.
We sign a business associate agreement before accessing protected health information, and access is limited to the named people on your account.
We look at your AR ageing, volume, payer mix and denial profile first, then tell you what we believe is recoverable and what it would cost.
A billing company is a poor fit if you are not willing to share visibility into your billing, if the vendor uses a rotating pool of people who never learn your practice, or if it cannot explain why your claims are being denied. Be wary of anyone promising large collection increases before they have seen your AR ageing. The right partner makes your revenue cycle more visible, not less.
One course of radiation produces charges across six phases, in three different systems, paid under different rules. Planning and management codes are professional-component-only, physics and delivery codes are technical-component-only, and image guidance now sits inside the delivery descriptor. On top of that, 77427, 77336, 77338 and 77470 each carry their own frequency rule, so the codes can be right while the units are wrong.
We charge 3% to 6% of collections, month to month, with no setup fee and no exit fee. A freestanding center collecting $4.2M a year pays about $189,000 at 4.5%, against $319,400 to run the same function in house. Fully loaded in-house billing cost 7.9% of collections for practices under $2M, across 96 practices that shared payroll data with us.
About two weeks from signed BAA to working claims, and first recovered payments in about three weeks. Median time from signed BAA to first claims worked was 9 business days across our client base. Nothing migrates: we work in your existing systems, and your old AR is worked alongside new claims rather than written off.
We work inside ARIA and MOSAIQ, and read planning and dosimetry evidence from Eclipse, RayStation, Velocity and MIM. Nothing is replaced and nothing is migrated. 38% of practice managers had changed EHR or practice management system in the past five years, and of those, 71% said collections dipped for at least six months after the switch.
Seven. Thirty fractions is six complete cycles of five, and the three remaining fractions bill as one more unit, because three or four fractions past a multiple of five count as one unit while one or two are not separately reportable. Each unit goes on its own claim line with the date of the last fraction in that cycle as the date of service.
Thirty minutes, no deck and no fee. We look at what is sitting past 90 days and where your denials cluster, and you leave knowing what is recoverable, what we would work first, and what it would cost.
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