Radiation Oncology Billing Services
Radiation oncology billing follows a patient through a long course of care. It starts with consultation and planning, moves into simulation and dosimetry, and then daily or weekly treatment delivery. Each phase has its own codes, and many of them depend on the type of treatment, such as intensity-modulated or stereotactic therapy.
Freestanding centers bill both professional and technical components. Hospital-based physicians bill only the professional side. Westmont Revenue Partners connects radiation oncology practices with vetted billing experts who know radiation oncology medical billing and can support the whole revenue cycle, from authorization through payment.
Who this is for
- Radiation oncologists in freestanding treatment centers
- Hospital-based physicians who bill professional services only
- Groups that own linear accelerators and bill the technical side
- Practices offering stereotactic and brachytherapy treatment
- Multi-site cancer centers with mixed payer contracts
What gets billed
- Initial consultation and treatment planning
- Simulation and treatment setup
- Dosimetry and dose calculations
- Treatment devices and beam-shaping tools
- Intensity-modulated radiation therapy planning and delivery
- Stereotactic body radiation therapy
- Image guidance during treatment
- Weekly treatment management
- Brachytherapy procedures
- On-treatment visits and follow-up care
- Prior authorization submissions
Commonly billed codes
| Code | Type | What it covers |
|---|---|---|
| 77263 | CPT | Complex clinical treatment planning by the physician |
| 77295 | CPT | Three-dimensional radiotherapy plan with dose-volume histograms |
| 77301 | CPT | Intensity-modulated radiation therapy planning |
| 77338 | CPT | Beam-shaping device design for intensity-modulated therapy |
| 77402 | CPT | External beam treatment delivery, level 1 (simplest), with imaging guidance when performed |
| 77407 | CPT | External beam treatment delivery, level 2, which now includes work once reported as intensity-modulated delivery |
| 77412 | CPT | External beam treatment delivery, level 3 (most complex), with imaging guidance when performed |
| 77373 | CPT | Stereotactic body radiation therapy delivery |
| 77427 | CPT | Radiation treatment management, each set of five fractions |
| 26 | Modifier | Professional component only |
| TC | Modifier | Technical component only |
Note
Codes are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.
Billing challenges in radiation oncology
Professional vs. technical component billing. Many radiation oncology codes can be split. In a hospital or hospital outpatient department, the facility bills the technical side on its own claim and the physician bills the professional side, often with modifier 26. In a freestanding center that owns the equipment, the practice may bill both parts globally. Treatment management codes, such as weekly management, are physician services and are not split in the same way. Billers confirm the setting and payer rules for every code.
- Long courses with many codes. Planning, simulation, and treatment each carry separate codes and rules. Billers track each phase and make sure charges are posted on the right date.
- Treatment management timing. Weekly management codes depend on the number of fractions delivered. Billers check fraction counts before posting so they are not billed too early.
- Bundling and code pairs. Some codes are bundled with others, such as certain image guidance and planning services. Billers use payer edits to avoid duplicate charges.
- Prior authorization. Many payers require approval for advanced techniques like intensity-modulated or stereotactic therapy. Billers verify the plan and request additional fractions in advance.
- Site-of-service differences. Hospital-based and freestanding billing follow different rules and fee schedules. Billers match claim format to the care setting.
- Payment model changes. Medicare and other payers have explored bundled payment ideas for radiation therapy. Billers watch current-year rules and notices.
- Documentation of medical necessity. Dose, site, and technique must match the diagnosis and plan. Billers coordinate with physicists and clinicians to resolve mismatches.
How Westmont can help
- Matching you with vetted billing experts experienced in radiation oncology
- End-to-end revenue cycle support, from authorization to payment posting
- Denial management for bundling and medical necessity issues
- Help with credentialing and payer enrollment
- Reports that separate professional and technical revenue
Frequently asked questions
Who bills the technical component in radiation oncology?
It depends on the setting. In a freestanding center, the practice that owns the equipment bills it. In a hospital outpatient department, the hospital bills technical services on its facility claim. The physician bills the professional work, often with modifier 26 where a code can be split.
How is weekly radiation treatment management billed?
Treatment management is generally billed in blocks tied to the number of fractions delivered, such as five at a time. Billers confirm the count before posting charges. Payers differ on how partial weeks are handled, so check each policy.
Do we need prior authorization for IMRT or SBRT?
Many commercial plans and Medicare Advantage plans require it, and some use outside vendors. Rules differ by plan and diagnosis. Verify requirements at consultation, and ask for enough fractions up front to avoid mid-course denials.
Why are some planning charges denied as bundled?
Payers use code-pair edits that treat some services as included in others. If planning, simulation, or image guidance is denied, compare the codes billed to the payer's edits and your documentation. A modifier may apply in limited cases, but it needs support.
Do hospital-employed radiation oncologists need to bill technical charges?
Usually not. When a hospital employs the physician and owns the equipment, the hospital bills facility charges. The physician group typically bills only professional services. Your contract and enrollment will show how responsibilities are divided.
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