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CPT code 77427: Radiation treatment management, per five treatment fractions2026 Medicare rate & RVUs in North Carolina

Radiation oncologist management of fractionated external beam therapy is reported in five-treatment units, with an additional unit when three or four fractions remain.

CMS RVU26DEffective Oct 1, 2026One payment locality858.3K Medicare services in 2024

In North Carolina, Medicare pays $187.29 for 77427 in the office and $187.29 when it’s performed in a hospital or facility.

$187.29Office (non-facility)
$187.29Hospital or facility
−4.2%vs the national office rate ($195.40)

Check a contract rate as a % of Medicare · 77427 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

We’ll open 77427 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 77427 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

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.

How North Carolina compares for 77427

Across 109 of 109 payment localities, the office rate for 77427 runs from $180.73 in Arkansas to $252.60 in Alaska. North Carolina pays $187.29. The RVUs are the same everywhere; the geographic indexes change the dollars.

77427 in North Carolina vs other payment areas
  1. North Carolina · this page$187.29
  2. Los Angeles, CA · California$210.66+$23.37
  3. Washington, DC area · District of Columbia$215.65+$28.36
  4. Miami, FL · Florida$211.71+$24.42
  5. Chicago, IL · Illinois$207.80+$20.51
  6. Manhattan, NY · New York$219.70+$32.41
  7. Alaska · Alaska$252.60+$65.31

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

77427 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$182.36$182.36
ArkansasArkansas$180.73$180.73
ArizonaArizona$191.85$191.85
Bakersfield, CACalifornia$201.26$201.26
Chico, CACalifornia$200.40$200.40
El Centro, CACalifornia$200.44$200.44
Fresno, CACalifornia$200.40$200.40
Hanford, CACalifornia$200.40$200.40

77427 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

$180.73

$252.60

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
77427 office rate range by state
State / territoryOffice rate rangeLocalities
AK$252.601
AL$182.361
AR$180.731
AZ$191.851
CA$200.40–$236.5229
CO$199.591
CT$205.181
DC$215.651
DE$194.191
FL$196.50–$211.713
GA$189.05–$198.662
GU$201.901
HI$201.901
IA$183.861
ID$184.891
IL$193.83–$207.804
IN$185.521
KS$183.971
KY$186.431
LA$186.50–$192.202
MA$199.36–$213.442
MD$196.70–$215.653
ME$186.18–$191.522
MI$190.06–$198.762
MN$191.431
MO$184.94–$191.853
MS$182.821
MT$195.381
NC$187.291
ND$190.241
NE$184.281
NH$197.351
NJ$207.56–$214.942
NM$190.991
NV$194.021
NY$189.11–$224.065
OH$189.011
OK$185.521
OR$192.52–$203.202
PA$188.84–$202.142
PR$196.081
RI$199.041
SC$188.461
SD$189.631
TN$184.631
TX$188.11–$199.048
UT$190.061
VA$191.58–$215.652
VI$196.081
VT$190.361
WA$198.71–$216.272
WI$186.271
WV$189.421
WY$193.141

See 77427 in every payment locality

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

Office or facility?

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.

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

9,104

Code
77427
Physician work
3.37
Practice expense
2.22
Malpractice
0.26

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 77427 in North Carolina
ComponentRVULocality factorAdjusted
Physician work3.37× 1.0003.3700
Practice expense2.22× 0.9332.0713
Malpractice0.26× 0.6390.1661
Total RVUs5.6074
Conversion factor× 33.4009

Office rate, North Carolina$187.29

Office: (3.37 × 1 + 2.22 × 0.933 + 0.26 × 0.639) × $33.4009 = $187.29

Facility: (3.37 × 1 + 2.22 × 0.933 + 0.26 × 0.639) × $33.4009 = $187.29

Open 77427 in the RVU calculator

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

RuleCMS valueWhat it means
Global periodXXXThe global surgery concept doesn’t apply.
Multiple procedures9The concept doesn’t apply.
Bilateral (modifier 50)9The concept doesn’t apply.
Assistant at surgery (80/81/82/AS)9The concept doesn’t apply.
Co-surgeons (62)9The concept doesn’t apply.
Team surgery (66)9The concept doesn’t apply.
Professional/technical2Professional component only.

Codes related to 77427

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 77427
CodeHow it relatesOffice range, North Carolina
Used instead
77431Radiation management, one or two treatmentsManagement for a complete course of only one or two fractions.$101.97
77432Stereotactic management, cranial, single-session courseManagement of a single-session cranial stereotactic radiosurgery course.$407.06
77435SBRT management, per treatment courseManagement of a stereotactic body radiation therapy course of up to five fractions.$615.19
77469IORT management, during surgeryManagement of intraoperative radiation therapy rather than fractionated external beam therapy.No office rate
Often billed with
77336Physics review, per week of therapyContinuing medical physics support reported alongside physician treatment management.$85.32
77412Radiation delivery, complex treatmentLevel 3 external beam delivery for fractions under physician management.$413.16
77417Port imaging, treatment-field verificationPort imaging whose physician review is included in treatment management.No office rate

How 77427 has changed in North Carolina

77427 · Office / nonfacility

$187.29

Effective 2026-10-01

The base rate is $7.48 higher than on 2025-10-01, moving from $179.81 to $187.29 (4.2%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release

  1. January 1, 2026

    RVU26A

    $179.81changed to$187.29

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 2.17 changed to 2.22
    • Malpractice RVU 0.27 changed to 0.26
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $181.74changed to$179.81

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 2.07 changed to 2.17
    • Malpractice RVU 0.26 changed to 0.27

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $178.77changed to$181.74

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $185.45changed to$178.77

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 2.06 changed to 2.07
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665

  5. January 1, 2023

    RVU23A

    $186.33changed to$185.45

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 1.95 changed to 2.06
    • Malpractice RVU 0.25 changed to 0.26
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $185.61changed to$186.33

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 1.88 changed to 1.95

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $189.54changed to$185.61

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 1.82 changed to 1.88
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $186.52changed to$189.54

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 1.76 changed to 1.82
    • Malpractice RVU 0.24 changed to 0.25
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    $184.30changed to$186.52

    • Conversion factor 35.9996 changed to 36.0391
    • Practice expense RVU 1.70 changed to 1.76

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2018

    RVU18AR1

    $182.71changed to$184.30

    • Conversion factor 35.8887 changed to 35.9996
    • Practice expense RVU 1.66 changed to 1.70
    • Malpractice GPCI 0.732 changed to 0.695

    Held through RVU18B, RVU18C, RVU18D.

  11. January 1, 2017

    RVU17A

    $181.54changed to$182.71

    • Conversion factor 35.8043 changed to 35.8887
    • Practice expense RVU 1.63 changed to 1.66
    • Practice expense GPCI 0.930 changed to 0.931
    • Malpractice GPCI 0.768 changed to 0.732

    Held through RVU17B, RVU17C, RVU17D.

  12. January 1, 2016

    RVU16A

    $181.35changed to$181.54

    • Conversion factor 35.9335 changed to 35.8043
    • Practice expense RVU 1.58 changed to 1.63
    • Malpractice RVU 0.27 changed to 0.24

    Held through RVU16B, RVU16C, RVU16D.

  13. July 1, 2015

    RVU15C

    $180.45changed to$181.35

    • Conversion factor 35.7547 changed to 35.9335

    Held through RVU15D.

  14. January 1, 2015

    RVU15A

    $179.79changed to$180.45

    • Conversion factor 35.8228 changed to 35.7547
    • Practice expense RVU 1.57 changed to 1.58
    • Malpractice RVU 0.26 changed to 0.27
    • Practice expense GPCI 0.929 changed to 0.930
    • Malpractice GPCI 0.732 changed to 0.768

    Held through RVU15B.

  15. January 1, 2014

    RVU14A

    $171.50changed to$179.79

    • Conversion factor 34.0230 changed to 35.8228
    • Practice expense RVU 1.60 changed to 1.57
    • Malpractice RVU 0.27 changed to 0.26
    • Practice expense GPCI 0.927 changed to 0.929
    • Malpractice GPCI 0.695 changed to 0.732

    Held through RVU14B, RVU14C, RVU14D.

  16. January 1, 2013

    RVU13AR

    Earliest loaded release: $171.50

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$187.29$187.29RVU26D
2026-07-01$187.29$187.29RVU26C
2026-04-01$187.29$187.29RVU26B
2026-01-01$187.29$187.29RVU26A
2025-10-01$179.81$179.81RVU25D
2025-07-01$179.81$179.81RVU25C
2025-04-01$179.81$179.81RVU25B
2025-01-01$179.81$179.81RVU25A
2024-10-01$181.74$181.74RVU24D
2024-07-01$181.74$181.74RVU24C
2024-04-01$181.74$181.74RVU24B
2024-03-09$181.74$181.74RVU24AR
2024-01-01$178.77$178.77RVU24A
2023-10-01$185.45$185.45RVU23D
2023-07-01$185.45$185.45RVU23C
2023-04-01$185.45$185.45RVU23B
2023-01-01$185.45$185.45RVU23A
2022-10-01$186.33$186.33RVU22D
2022-07-01$186.33$186.33RVU22C
2022-04-01$186.33$186.33RVU22B
2022-01-01$186.33$186.33RVU22A
2021-10-01$185.61$185.61RVU21D
2021-07-01$185.61$185.61RVU21C
2021-04-01$185.61$185.61RVU21B
2021-01-01$185.61$185.61RVU21A
2020-10-01$189.54$189.54RVU20D
2020-07-01$189.54$189.54RVU20C
2020-04-01$189.54$189.54RVU20B
2020-01-01$189.54$189.54RVU20A
2019-10-01$186.52$186.52RVU19D
2019-07-01$186.52$186.52RVU19C
2019-04-01$186.52$186.52RVU19B
2019-01-01$186.52$186.52RVU19A
2018-10-01$184.30$184.30RVU18D
2018-07-01$184.30$184.30RVU18C
2018-04-01$184.30$184.30RVU18B
2018-01-01$184.30$184.30RVU18AR1
2017-10-01$182.71$182.71RVU17D
2017-07-01$182.71$182.71RVU17C
2017-04-01$182.71$182.71RVU17B
2017-01-01$182.71$182.71RVU17A
2016-10-01$181.54$181.54RVU16D
2016-07-01$181.54$181.54RVU16C
2016-04-01$181.54$181.54RVU16B
2016-01-01$181.54$181.54RVU16A
2015-10-01$181.35$181.35RVU15D
2015-07-01$181.35$181.35RVU15C
2015-04-01$180.45$180.45RVU15B
2015-01-01$180.45$180.45RVU15A
2014-10-01$179.79$179.79RVU14D
2014-07-01$179.79$179.79RVU14C
2014-04-01$179.79$179.79RVU14B
2014-01-01$179.79$179.79RVU14A
2013-10-01$171.50$171.50RVU13D
2013-07-01$171.50$171.50RVU13C
2013-04-01$171.50$171.50RVU13B
2013-01-01$171.50$171.50RVU13AR

Price 77427 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

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

Show the CMS file lines behind this rate
RVUs for 77427PPRRVU2026_Oct_nonQPP.csv, line 9,104 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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