CPT code 77427: Radiation treatment management, per five treatment fractions2026 Medicare rate & RVUs in Louisiana
Radiation oncologist management of fractionated external beam therapy is reported in five-treatment units, with an additional unit when three or four fractions remain.
Medicare pays $186.50–$192.20 for 77427 in the office in Louisiana, from Rest of Louisiana to New Orleans, LA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 77427 covers
This code covers a radiation oncologist's ongoing oversight of fractionated external beam therapy, such as a multiweek course for breast, prostate, lung, or head and neck cancer. Management includes reviewing verification images and dosimetry, checking dose delivery and treatment parameters, assessing patient setup, and evaluating treatment response and side effects. The service is provided in hospital outpatient departments and freestanding radiation oncology centers.
Report one unit for each five delivered treatment fractions, regardless of calendar days. Distinct twice-daily treatment sessions count separately. At the end of a course, three or four fractions beyond the last full group of five support another unit; one or two do not. Use 77431 instead when the entire course consists of only one or two fractions. Documentation should support the oncologist's patient evaluation and review of treatment images, dosimetry, and delivery. Medicare treats 77427 as professional-only work: do not append modifier 26. Technical delivery and imaging are reported with separate codes when performed.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 77427 pays more and less in Louisiana
| Payment locality | Office | Facility |
|---|---|---|
| New Orleans, LA | $192.20 | $192.20 |
| Rest of Louisiana | $186.50 | $186.50 |
How the 77427 rate is calculated
Each of 77427’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 77427
RVUs × geographic indexes × conversion factor
Work3.37
3.37 RVUs× 1.000 GPCI
Practice expense2.22
2.22 RVUs× 1.000 GPCI
Malpractice0.26
0.26 RVUs× 1.000 GPCI
Adjusted RVUs
5.8500
Conversion factor
$33.4009
Medicare rate
$195.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77427
The CMS indicators that decide how 77427 is paid alongside other services.
CMS payment indicators · 77427
Radiation treatment management, per five treatment fractions
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 2 | Professional component only. |
77427 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 77431Radiation managementOne or two treatments
- 77431 is reported for an entire course of only one or two fractions; 77427 applies to courses of three or more fractions, using five-treatment units and the end-of-course remainder rule.
- 77435SBRT managementPer treatment course
- 77435 manages a stereotactic body radiation therapy course of up to five fractions. Do not report 77427 for management of the same SBRT course.
- 77432Stereotactic managementCranial, single-session course
- 77432 manages a single-session cranial stereotactic radiosurgery course; 77427 covers fractionated radiation treatment management.
- 77469IORT managementDuring surgery
- 77469 covers physician management of radiation delivered during surgery; 77427 covers management across a fractionated treatment course.
77427 billing questions
How many units are reported for a 28-fraction course?
Report six units: five for the first 25 fractions and one for the remaining three. A remainder of only one or two fractions would not support another unit.
When should 77431 be used instead?
Use 77431 when the entire treatment course consists of only one or two fractions. A course of three or more fractions is managed with 77427.
Can E/M visits be billed during the treatment course?
Routine on-treatment evaluation for the condition being irradiated is included in treatment management. A separately identifiable visit for an unrelated problem may be reported when documented; append modifier 25 to the E/M code when needed to distinguish a same-day service.
Does modifier 26 need to be appended?
No. 77427 is already a professional-only code; technical delivery and imaging are reported under separate codes.
Do twice-daily treatments count as two fractions?
Yes. When treatment is delivered in two distinct sessions on the same day, each session counts toward the five-treatment unit.
Is review of port films or verification images separately billable?
The oncologist's review is part of treatment management. Port image acquisition, such as 77417, is a separate technical service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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