CPT code 77427: Radiation treatment management, per five treatment fractions2026 Medicare rate & RVUs in North Dakota
Radiation oncologist management of fractionated external beam therapy is reported in five-treatment units, with an additional unit when three or four fractions remain.
In North Dakota, Medicare pays $190.24 for 77427 in the office and $190.24 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Dakota 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 Dakota pays $190.24. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$190.24
- Los Angeles, CA · California$210.66+$20.42
- Washington, DC area · District of Columbia$215.65+$25.41
- Miami, FL · Florida$211.71+$21.47
- Chicago, IL · Illinois$207.80+$17.56
- Manhattan, NY · New York$219.70+$29.46
- Alaska · Alaska$252.60+$62.36
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $200.40 | $200.40 |
| Merced, CACalifornia | $200.40 | $200.40 |
| Modesto, CACalifornia | $200.40 | $200.40 |
| Napa, CACalifornia | $221.79 | $221.79 |
| Oxnard, CACalifornia | $208.77 | $208.77 |
| Redding, CACalifornia | $200.40 | $200.40 |
| Rest of CaliforniaCalifornia | $200.40 | $200.40 |
| Riverside, CACalifornia | $203.26 | $203.26 |
| Sacramento, CACalifornia | $207.50 | $207.50 |
| Salinas, CACalifornia | $206.65 | $206.65 |
| San Diego, CACalifornia | $209.33 | $209.33 |
| Marin County, CACalifornia | $231.79 | $231.79 |
| San Francisco, CACalifornia | $231.50 | $231.50 |
| San Benito County, CACalifornia | $236.52 | $236.52 |
| Santa Clara County, CACalifornia | $235.31 | $235.31 |
| San Luis Obispo, CACalifornia | $203.59 | $203.59 |
| Santa Cruz, CACalifornia | $209.67 | $209.67 |
| Santa Maria, CACalifornia | $206.83 | $206.83 |
| Santa Rosa, CACalifornia | $211.65 | $211.65 |
| Stockton, CACalifornia | $200.40 | $200.40 |
| Vallejo, CACalifornia | $221.37 | $221.37 |
| Visalia, CACalifornia | $200.40 | $200.40 |
| Yuba City, CACalifornia | $200.40 | $200.40 |
| ColoradoColorado | $199.59 | $199.59 |
| ConnecticutConnecticut | $205.18 | $205.18 |
| DelawareDelaware | $194.19 | $194.19 |
| Fort Lauderdale, FLFlorida | $203.38 | $203.38 |
| Rest of FloridaFlorida | $196.50 | $196.50 |
| Atlanta, GAGeorgia | $198.66 | $198.66 |
| Rest of GeorgiaGeorgia | $189.05 | $189.05 |
| Hawaii, Guam, HIHawaii | $201.90 | $201.90 |
| IowaIowa | $183.86 | $183.86 |
| IdahoIdaho | $184.89 | $184.89 |
| East St. Louis, ILIllinois | $198.27 | $198.27 |
| Rest of IllinoisIllinois | $193.83 | $193.83 |
| Suburban Chicago, ILIllinois | $204.89 | $204.89 |
| IndianaIndiana | $185.52 | $185.52 |
| KansasKansas | $183.97 | $183.97 |
| KentuckyKentucky | $186.43 | $186.43 |
| New Orleans, LALouisiana | $192.20 | $192.20 |
| Rest of LouisianaLouisiana | $186.50 | $186.50 |
| Metropolitan Boston, MAMassachusetts | $213.44 | $213.44 |
| Rest of MassachusettsMassachusetts | $199.36 | $199.36 |
| Baltimore area, MDMaryland | $204.67 | $204.67 |
| Rest of MarylandMaryland | $196.70 | $196.70 |
| Rest of MaineMaine | $186.18 | $186.18 |
| Southern Maine, MEMaine | $191.52 | $191.52 |
| Detroit, MIMichigan | $198.76 | $198.76 |
| Rest of MichiganMichigan | $190.06 | $190.06 |
| MinnesotaMinnesota | $191.43 | $191.43 |
| Metropolitan Kansas City, MOMissouri | $190.67 | $190.67 |
| Metropolitan St. Louis, MOMissouri | $191.85 | $191.85 |
| Rest of MissouriMissouri | $184.94 | $184.94 |
| MississippiMississippi | $182.82 | $182.82 |
| MontanaMontana | $195.38 | $195.38 |
| North CarolinaNorth Carolina | $187.29 | $187.29 |
| NebraskaNebraska | $184.28 | $184.28 |
| New HampshireNew Hampshire | $197.35 | $197.35 |
| Northern New JerseyNew Jersey | $214.94 | $214.94 |
| Rest of New JerseyNew Jersey | $207.56 | $207.56 |
| New MexicoNew Mexico | $190.99 | $190.99 |
| NevadaNevada | $194.02 | $194.02 |
| NYC suburbs and Long Island, NYNew York | $224.06 | $224.06 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $209.33 | $209.33 |
| Queens, NYNew York | $219.93 | $219.93 |
| Rest of New YorkNew York | $189.11 | $189.11 |
| OhioOhio | $189.01 | $189.01 |
| OklahomaOklahoma | $185.52 | $185.52 |
| Portland, OROregon | $203.20 | $203.20 |
| Rest of OregonOregon | $192.52 | $192.52 |
| Metropolitan Philadelphia, PAPennsylvania | $202.14 | $202.14 |
| Rest of PennsylvaniaPennsylvania | $188.84 | $188.84 |
| Puerto RicoPuerto Rico | $196.08 | $196.08 |
| Rhode IslandRhode Island | $199.04 | $199.04 |
| South CarolinaSouth Carolina | $188.46 | $188.46 |
| South DakotaSouth Dakota | $189.63 | $189.63 |
| TennesseeTennessee | $184.63 | $184.63 |
| Austin, TXTexas | $198.93 | $198.93 |
| Beaumont, TXTexas | $188.11 | $188.11 |
| Brazoria, TXTexas | $193.72 | $193.72 |
| Dallas, TXTexas | $194.88 | $194.88 |
| Fort Worth, TXTexas | $194.25 | $194.25 |
| Galveston, TXTexas | $194.28 | $194.28 |
| Houston, TXTexas | $199.04 | $199.04 |
| Rest of TexasTexas | $190.77 | $190.77 |
| UtahUtah | $190.06 | $190.06 |
| VirginiaVirginia | $191.58 | $191.58 |
| Virgin Islands, VIUnited States Virgin Islands | $196.08 | $196.08 |
| VermontVermont | $190.36 | $190.36 |
| Rest of WashingtonWashington | $198.71 | $198.71 |
| King County, WAWashington | $216.27 | $216.27 |
| WisconsinWisconsin | $186.27 | $186.27 |
| West VirginiaWest Virginia | $189.42 | $189.42 |
| WyomingWyoming | $193.14 | $193.14 |
77427 rates by state
Office rate range in each state. Select a state to see its payment localities.
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $252.60 | 1 |
| AL | $182.36 | 1 |
| AR | $180.73 | 1 |
| AZ | $191.85 | 1 |
| CA | $200.40–$236.52 | 29 |
| CO | $199.59 | 1 |
| CT | $205.18 | 1 |
| DC | $215.65 | 1 |
| DE | $194.19 | 1 |
| FL | $196.50–$211.71 | 3 |
| GA | $189.05–$198.66 | 2 |
| GU | $201.90 | 1 |
| HI | $201.90 | 1 |
| IA | $183.86 | 1 |
| ID | $184.89 | 1 |
| IL | $193.83–$207.80 | 4 |
| IN | $185.52 | 1 |
| KS | $183.97 | 1 |
| KY | $186.43 | 1 |
| LA | $186.50–$192.20 | 2 |
| MA | $199.36–$213.44 | 2 |
| MD | $196.70–$215.65 | 3 |
| ME | $186.18–$191.52 | 2 |
| MI | $190.06–$198.76 | 2 |
| MN | $191.43 | 1 |
| MO | $184.94–$191.85 | 3 |
| MS | $182.82 | 1 |
| MT | $195.38 | 1 |
| NC | $187.29 | 1 |
| ND | $190.24 | 1 |
| NE | $184.28 | 1 |
| NH | $197.35 | 1 |
| NJ | $207.56–$214.94 | 2 |
| NM | $190.99 | 1 |
| NV | $194.02 | 1 |
| NY | $189.11–$224.06 | 5 |
| OH | $189.01 | 1 |
| OK | $185.52 | 1 |
| OR | $192.52–$203.20 | 2 |
| PA | $188.84–$202.14 | 2 |
| PR | $196.08 | 1 |
| RI | $199.04 | 1 |
| SC | $188.46 | 1 |
| SD | $189.63 | 1 |
| TN | $184.63 | 1 |
| TX | $188.11–$199.04 | 8 |
| UT | $190.06 | 1 |
| VA | $191.58–$215.65 | 2 |
| VI | $196.08 | 1 |
| VT | $190.36 | 1 |
| WA | $198.71–$216.27 | 2 |
| WI | $186.27 | 1 |
| WV | $189.42 | 1 |
| WY | $193.14 | 1 |
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.
The exact North Dakota 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
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.37 | × 1.000 | 3.3700 |
| Practice expense | 2.22 | × 1.000 | 2.2200 |
| Malpractice | 0.26 | × 0.406 | 0.1056 |
| Total RVUs | 5.6956 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$190.24
Office: (3.37 × 1 + 2.22 × 1 + 0.26 × 0.406) × $33.4009 = $190.24
Facility: (3.37 × 1 + 2.22 × 1 + 0.26 × 0.406) × $33.4009 = $190.24
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. |
How 77427 has changed in North Dakota
77427 · Office / nonfacility
$190.24
Effective 2026-10-01
The base rate is $6.53 higher than on 2025-10-01, moving from $183.71 to $190.24 (3.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$183.71changed to$190.24
- 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
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$185.56changed to$183.71
- 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.
March 9, 2024
RVU24AR
$182.53changed to$185.56
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$188.18changed to$182.53
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 2.06 changed to 2.07
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$187.83changed to$188.18
- 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
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$186.95changed to$187.83
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.88 changed to 1.95
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$191.68changed to$186.95
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.82 changed to 1.88
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$189.55changed to$191.68
- 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
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$187.18changed to$189.55
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.70 changed to 1.76
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$185.23changed to$187.18
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.66 changed to 1.70
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$183.78changed to$185.23
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 1.63 changed to 1.66
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$183.25changed to$183.78
- 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.
July 1, 2015
RVU15C
$182.33changed to$183.25
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$181.96changed to$182.33
- 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
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$173.84changed to$181.96
- 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
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $173.84
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $190.24 | $190.24 | RVU26D |
| 2026-07-01 | $190.24 | $190.24 | RVU26C |
| 2026-04-01 | $190.24 | $190.24 | RVU26B |
| 2026-01-01 | $190.24 | $190.24 | RVU26A |
| 2025-10-01 | $183.71 | $183.71 | RVU25D |
| 2025-07-01 | $183.71 | $183.71 | RVU25C |
| 2025-04-01 | $183.71 | $183.71 | RVU25B |
| 2025-01-01 | $183.71 | $183.71 | RVU25A |
| 2024-10-01 | $185.56 | $185.56 | RVU24D |
| 2024-07-01 | $185.56 | $185.56 | RVU24C |
| 2024-04-01 | $185.56 | $185.56 | RVU24B |
| 2024-03-09 | $185.56 | $185.56 | RVU24AR |
| 2024-01-01 | $182.53 | $182.53 | RVU24A |
| 2023-10-01 | $188.18 | $188.18 | RVU23D |
| 2023-07-01 | $188.18 | $188.18 | RVU23C |
| 2023-04-01 | $188.18 | $188.18 | RVU23B |
| 2023-01-01 | $188.18 | $188.18 | RVU23A |
| 2022-10-01 | $187.83 | $187.83 | RVU22D |
| 2022-07-01 | $187.83 | $187.83 | RVU22C |
| 2022-04-01 | $187.83 | $187.83 | RVU22B |
| 2022-01-01 | $187.83 | $187.83 | RVU22A |
| 2021-10-01 | $186.95 | $186.95 | RVU21D |
| 2021-07-01 | $186.95 | $186.95 | RVU21C |
| 2021-04-01 | $186.95 | $186.95 | RVU21B |
| 2021-01-01 | $186.95 | $186.95 | RVU21A |
| 2020-10-01 | $191.68 | $191.68 | RVU20D |
| 2020-07-01 | $191.68 | $191.68 | RVU20C |
| 2020-04-01 | $191.68 | $191.68 | RVU20B |
| 2020-01-01 | $191.68 | $191.68 | RVU20A |
| 2019-10-01 | $189.55 | $189.55 | RVU19D |
| 2019-07-01 | $189.55 | $189.55 | RVU19C |
| 2019-04-01 | $189.55 | $189.55 | RVU19B |
| 2019-01-01 | $189.55 | $189.55 | RVU19A |
| 2018-10-01 | $187.18 | $187.18 | RVU18D |
| 2018-07-01 | $187.18 | $187.18 | RVU18C |
| 2018-04-01 | $187.18 | $187.18 | RVU18B |
| 2018-01-01 | $187.18 | $187.18 | RVU18AR1 |
| 2017-10-01 | $185.23 | $185.23 | RVU17D |
| 2017-07-01 | $185.23 | $185.23 | RVU17C |
| 2017-04-01 | $185.23 | $185.23 | RVU17B |
| 2017-01-01 | $185.23 | $185.23 | RVU17A |
| 2016-10-01 | $183.78 | $183.78 | RVU16D |
| 2016-07-01 | $183.78 | $183.78 | RVU16C |
| 2016-04-01 | $183.78 | $183.78 | RVU16B |
| 2016-01-01 | $183.78 | $183.78 | RVU16A |
| 2015-10-01 | $183.25 | $183.25 | RVU15D |
| 2015-07-01 | $183.25 | $183.25 | RVU15C |
| 2015-04-01 | $182.33 | $182.33 | RVU15B |
| 2015-01-01 | $182.33 | $182.33 | RVU15A |
| 2014-10-01 | $181.96 | $181.96 | RVU14D |
| 2014-07-01 | $181.96 | $181.96 | RVU14C |
| 2014-04-01 | $181.96 | $181.96 | RVU14B |
| 2014-01-01 | $181.96 | $181.96 | RVU14A |
| 2013-10-01 | $173.84 | $173.84 | RVU13D |
| 2013-07-01 | $173.84 | $173.84 | RVU13C |
| 2013-04-01 | $173.84 | $173.84 | RVU13B |
| 2013-01-01 | $173.84 | $173.84 | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
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
Fee sheets · Coming soon
Put 77427 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist