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Radiation Oncology Billing Services
Radiation oncology billing follows the course — planning, simulation, dosimetry, delivery by fraction, and weekly management — not a clinic E/M line with a linear-accelerator icon. Vector Medical Billing, in Jamaica, New York, reconciles charges to the treatment record, splits professional and technical components for your site of service, and runs the claim cycle inside the oncology information system you already use.
98%Published NCR
24hClaim Submission
BAASigned with every client
AAPCCertified coders
AHIMACertified coders
E&OErrors and omissions insured
50 StatesRemote billing nationwide
Monthly fee
What radiation oncology billing services include
Full-cycle RCM for freestanding radiation centers, physician radiation oncology groups, and multi-modality cancer programs — course by course.
The operating cycle matches medical billing services: eligibility, charge capture from the treatment record, ICD-10 / CPT coding, scrub, clearinghouse submission, payment posting, denial management, and A/R follow-up. The scrub watches planning complexity, simulation level, IMRT packaging, fraction delivery, weekly management units, 26/TC splits, and course authorization.
In scope: external-beam courses (3D conformal, IMRT/VMAT when documented), stereotactic (SRS/SBRT), image guidance when separately reportable for the setting, physics and special procedures when documented, and brachytherapy when it sits on the same account. Hospital facility-only technical bills on UB-04 stay out unless separately agreed. Medical-oncology drug and infusion billing sits on oncology billing when that is a separate ledger.
Radiation oncology is priced as a percentage of net collections. Credentialing, a retrospective coding audit, MIPS, and out-of-network / IDR stay separate engagements.
What sits on this radiation oncology fee
- Course charges reconciled to the treatment calendar — not a recycled plan code
- 26 / TC / global logic matched to freestanding vs hospital ownership
- HIPAA workflows, a signed BAA, and PHI limited to staff on the account
Where radiation oncology claims fail
Common radiation oncology billing issues include planning codes packaged into IMRT and billed again, delivery or weekly management that does not match the fractions given, and the wrong professional or technical component for the setting.
Planning packaged into IMRT
IMRT planning (77301) is generally once per course. CMS packages specific simulation, 3D planning, and related physics codes into IMRT plan development when they are part of building that plan. Stacking those lines on top of 77301 is a classic edit.
Vector codes the plan the record supports — and does not re-bill packaged prep work as if it were a separate course.
Delivery vs management drift
Daily delivery must match fractions actually delivered. Weekly management (77427) follows the five-fraction rule — including the three/four leftover rule at course end — and needs a physician face-to-face exam per unit. Billing management ahead of fractions, or stereotactic delivery under standard weekly rules, breaks the course.
The scrub reconciles the delivery log to management units before submission.
Wrong 26 / TC or setting
Physics and many planning services split professional and technical. Hospital outpatient technical work often sits with the facility; freestanding centers commonly bill global or TC. Mixing those paths — or billing physician admin codes that belong to the hospital — triggers component and place-of-service denials.
Vector matches modifiers to who owns the equipment and who performs the professional work.
Plan · sim · deliver · manage
The course sequence — not a clinic visit
Planning, treatment delivery, and weekly management are separate from a routine office visit.
Clinical treatment planning (77261–77263) follows documented complexity — simple, intermediate, or complex — not a default mid-level habit. Simulation-aided field setting (77280–77290) and 3D planning (77295) track the technique actually used. Dosimetry calculations and treatment devices (including IMRT multi-leaf collimator devices when supported) attach to the plan, not to a recycled charge template.
Delivery is billed per fraction actually treated, using the delivery family that matches modality, setting, and the current fee schedule for that account. Image guidance rides with delivery rules for the payer and site of service. Weekly physician management is its own professional line — not bundled into a same-day clinic E/M by habit.
What the scrub checks on each course
- Planning complexity and simulation level match the documented technique
- Delivery fractions reconcile to the treatment calendar
- Diagnosis pointers and auth support medical necessity for the modality
IMRT planning, devices, and packaging
Inverse planning has its own once-per-course logic — stacking packaged prep work is how denials start.
77301 once per course
IMRT plan development includes dose-volume work for targets and organs at risk. A second 77301 in the same course needs a new CT/MRI dataset showing substantial change in target or anatomy, plus a physician statement of medical necessity in the record.
Packaged planning services
When CMS packages listed simulation, 3D planning, and related physics codes into IMRT plan payment for the setting, those services are not separately reported as part of building that plan. Vector follows the packaging rule for the site of service — hospital APC vs freestanding — instead of one national habit.
Devices and dosimetry
Basic dosimetry (77300), special dosimetry when documented, and treatment devices (including 77338 for IMRT MLC devices when the plan supports them) are captured from the physics and planning record — not assumed because “every IMRT gets a device line.”
SRS, SBRT, and stereotactic management
Fraction caps and management codes differ from standard external-beam weekly billing.
SRS delivery
Stereotactic radiosurgery delivery uses modality-specific codes (for example Cobalt multi-source vs linear-accelerator single-session families). Cranial single-fraction courses follow SRS rules; multi-fraction cranial work often moves into SBRT logic. Image guidance is typically included in stereotactic delivery — do not stack a second delivery code the same day.
SBRT fraction limit
SBRT delivery is reported per fraction with the entire course not exceeding five fractions. Courses beyond five fractions are not billed as SBRT. Only one treatment delivery code per day of SBRT, regardless of lesions or sessions that day.
Stereotactic management
SRS and SBRT use dedicated management codes (for example 77432 / 77435 paths) billed once per course under their own rules — not standard 77427 five-fraction weekly management stacked on top of a stereotactic course.
Weekly treatment management (77427)
Professional-only management tied to fractions delivered — and to a physician exam.
Five-fraction units
CPT 77427 is reported once per five fractions or treatment sessions, regardless of calendar week length. Three or four fractions beyond a multiple of five at course end may support one additional unit; one or two leftovers generally do not. Payment timing follows carrier rules — often after the fifth fraction of the unit, except when the entire course is only three or four fractions.
Short complete courses of one or two fractions (non-stereotactic) use 77431 instead of inventing weekly units.
Physician face-to-face required
ASTRO and CMS describe management as clinical evaluation, review of images, review of dosimetry and treatment parameters, and review of setup. At least one examination of the patient by the radiation oncologist is required for each reported 77427 unit. A nurse practitioner exam alone does not satisfy physician billing of 77427.
Vector does not bill a management unit when the fraction count or the face-to-face note cannot support it.
Professional vs technical components
Who owns the machine and who performs the professional work decides 26, TC, or global.
Modifier 26 — professional
Physician work for planning, physics interpretation, and management when the technical component sits with the hospital or another entity. PC/TC indicator must allow the split.
Modifier TC — technical
Equipment, supplies, and technical staff. Freestanding centers often own this piece. Hospital outpatient technical radiation services commonly bill on the facility claim — not as physician TC on a professional claim.
Global — both
Same entity owns technical delivery and professional oversight: bill without 26/TC where global is appropriate. Double-billing global plus a component line for the same service is a takeback pattern.
Prior authorization and course reconciliation
Auth is tied to modality and fraction count — not only to the patient’s name.
Commercial and Medicare Advantage plans commonly authorize radiation by technique (IMRT vs 3D vs SBRT), anatomic site, and planned fractions. A mid-course modality change or fraction extension that exceeds the approval turns delivered fractions into denials after the patient has already been treated.
Vector ties prior authorization to the planned course, flags drift against the treatment calendar, and reconciles every finalized course so delivered fractions become claims — or documented holds — instead of silent write-offs.
Controls before the claim leaves
- Auth modality and fraction count match what will be billed
- Delivery log reconciled to management units for the course
- Component modifiers match freestanding vs hospital ownership
Auth · fractions · components
Radiation oncology code families this service works
Illustrative anchors — the treatment record, site of service, and current fee schedule decide the final claim.
| Work type | Example | What to check | Common failure if skipped |
|---|---|---|---|
| Clinical planning | 77261–77263 | Complexity vs documented decision-making | Default mid-level every course |
| Simulation / 3D | 77280–77290; 77295 | Technique; IMRT packaging rules | Sim stacked under 77301 when packaged |
| IMRT planning | 77301 | Once per course; second-plan criteria | Repeat 77301 without new dataset |
| Dosimetry / devices | 77300; 77332–77338 | Documented calculations and devices | Assumed device on every IMRT |
| Delivery | Technique + setting family | Fractions delivered; current fee schedule | Undelivered fractions billed |
| Weekly management | 77427 / 77431 | Five-fraction rule; MD face-to-face | Management without exam or leftover math |
| SRS / SBRT | 77371–77373; 77432 / 77435 | Fraction caps; once-per-course management | SBRT beyond five fractions; dual delivery same day |
| Components | 26 / TC / global | Who owns tech; who does professional work | Global on hospital-tech course |
This page does not invent a radiation oncology denial percentage. The free audit reads your packaging errors, fraction mismatches, and 77427 gaps on the sample you send.
What a free audit line looks like
Illustrative composite only — not a client result and not a promised recovery.
| Field | Example entry |
|---|---|
| Documented service | Freestanding IMRT course; 77301 documented once; 23 fractions delivered; physician weekly exams documented for each five-fraction block; hospital does not own technical |
| Billed codes | 77301 ×2 without new imaging dataset; simulation codes also billed as part of same IMRT plan build; 77427 ×6 for 23 fractions; second 77301 same week as first |
| Issue found | Second IMRT plan unsupported; packaged sim stacked under 77301; 23 fractions support four full 77427 units plus leftover math (3 leftovers → one more unit = 5), not six |
| Recommended correction | One 77301; drop packaged sim lines tied to that plan; bill 77427 units matching five-fraction + leftover rules with MD exams on file |
| Related check | Confirm auth fraction count and global vs 26/TC for freestanding ownership |
| Why it matters | Stacked packaging + management overbill on one course — caught in scrub or flagged in the free audit |
Request a Free Audit with recent treatment summaries, claims, and denials. We map planning, fractions, and 77427 on your file — not this composite.
How Vector runs radiation oncology billing
Specialty assignment and course reconciliation first — then the same revenue cycle.
1
Assign rad onc
Coder and biller who already work planning packaging, fractions, 77427, and 26/TC by setting.
2
Reconcile and code
Charge entry and coding from the treatment record — queries when fractions or plans cannot be supported.
Not inside the radiation oncology percentage
Related work stays separate so the quote matches the job.
Credentialing
Provider credentialing for radiation oncologists across commercial and Medicare Advantage panels is a separate project.
Coding audit
A retrospective billing and coding audit of packaging, fractions, and 77427 is scoped on its own when you want a period review.
Underpay / OON
Underpayment recovery and OON / IDR are separate when the dispute path is not ordinary denial work.
How radiation oncology billing is priced
Percentage of dollars that land — not a flat fee per fraction that ignores hard packaging denials.
Written rate
Radiation oncology is priced as a percentage of net collections. No setup fee on the monthly cycle. Month to month. The written rate follows course volume, modality mix, payer mix, and how much of the cycle you hand over.
See pricing or request a written rate after the free audit.
What we need to start
OIS/EHR access, monthly course volume and modality mix, fee schedule or payer mix, open A/R if you are leaving another biller, and a sample of recent packaging or 77427 denials. Switching usually overlaps so claim submission does not stop. See EHR integration if access setup needs a separate quote.
Audit the radiation oncology claims that are already failing
Send monthly course volume, top modalities and payers, OIS name, and a sample of packaging or management denials. We reply with what the open A/R shows, whether the monthly fee fits, and a written rate — without inventing a clean-claim percentage.
Written
Monthly rate
98%
Published NCR
50
US States
BAA
Every Client
Radiation oncology billing questions
Straight answers tied to the sections above.
What does radiation oncology billing include?
Course-based charge capture for planning, simulation, dosimetry and devices, IMRT and stereotactic work when documented, treatment delivery by fraction, weekly management, 26/TC splits, prior authorization for the course, claim scrubbing, submission, payment posting, denial management, and A/R follow-up.
How much do radiation oncology billing services cost?
The fee is a percentage of net collections. No setup fee on the monthly cycle. The written rate follows course volume, modality mix, and payer mix.
How is radiation oncology different from a clinic visit?
A radiation course bills planning, delivery, and weekly management as separate work from a routine office visit. Fraction counts, modality rules, and professional vs technical splits decide the claim — not a single E/M superbill.
How is CPT 77427 billed?
77427 is radiation treatment management reported once per five fractions. Three or four leftover fractions at course end may support one additional unit; one or two generally do not. The radiation oncologist must personally perform at least one face-to-face examination for each reported unit.
How often is IMRT planning billed?
77301 is generally once per course. A second plan needs a new imaging dataset with substantial anatomic or target change plus physician medical-necessity documentation. Codes CMS packages into IMRT planning should not be stacked on the same plan build.
Do we have to change our EHR or OIS?
No. Billers work in the system you already use — see EHR integration. Compatibility is confirmed before you commit.
Where does Vector provide radiation oncology billing?
The office is 15717 85th St, Jamaica, NY 11414-2620. Work is remote for radiation oncology practices in all 50 states. See the specialties hub.
Is Vector Medical Billing HIPAA certified?
HHS does not certify billing companies. Vector signs a BAA, limits PHI to staff on the account, and follows HIPAA workflows. A HIPAA security risk analysis is a separate engagement when scoped.