CPT code 77469: IORT management, during surgery2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 77469 in California.

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

What 77469 covers

This service represents the radiation oncologist’s management of radiation delivered in the operating room during a surgical procedure. Intraoperative radiation therapy may be used to treat a tumor bed or other selected target while the area is exposed during surgery. The radiation oncologist coordinates and manages the treatment in the operative setting with the surgical team; this is different from the technical act of delivering the beam.

Report 77469 for the management service when intraoperative radiation treatment is performed, and distinguish it from the modality-specific delivery service, such as intraoperative x-ray or electron treatment. Documentation should identify the operative treatment, the physician’s management work, and the relationship to the surgical procedure and radiation delivery. The code is not the selection for routine fraction-based radiation management or for stereotactic treatment management; those services have their own codes. CMS assigns work and practice expense values to this service.

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 77469 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the 77469 rate is calculated

Each of 77469’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.

Payment rules and modifiers for 77469

77469 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

77469 compared with similar codes

How to choose

77424Intraoperative radiationX-ray delivery

77424 represents intraoperative radiation delivery by x-ray. Use 77469 for the physician’s management service, not as a substitute for the delivery code.

77425Intraoperative radiationElectron beam

77425 represents intraoperative radiation delivery by electrons. It identifies the delivery modality, while 77469 represents management.

77427Radiation treatment managementPer five treatment fractions

77427 is radiation treatment management counted in groups of five treatments. 77469 is specific to management of treatment delivered during surgery.

77470Special radiationAdditional treatment complexity

77470 represents a special radiation treatment procedure, whereas 77469 specifically identifies management of intraoperative radiation treatment.

Codes related to 77469

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

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

Open CMS sourceHow we calculate rates