Billing code 77387: Radiation guidanceMedicare rate & RVUs
Reports image-based localization, tracking, and patient positioning during radiation treatment delivery, including acquisition and interpretation of the treatment images.
Medicare pays $36.41 for 77387 nationally in the office. Local office rates run $34.13–$48.14.
Medicare rate · 77387
Radiation guidance
Swap in your local Medicare rate.
- Work RVUs
- 0.68
- Total RVUs
- 1.09
- Global days
- XXX
National rate · 2026
$36.41
Office setting, before claim adjustments.
See every locality for 77387 → · Billed by an NP, PA or therapist? →
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 10 sections
What 77387 covers
This service uses imaging during radiation treatment to localize the target, track its position, and align the patient before or during delivery. Radiation therapists and other treatment staff acquire images using the treatment system; the radiation oncologist or another qualified professional interprets them and determines whether positioning or alignment needs adjustment. Examples include on-board imaging used to verify setup for a treatment fraction.
Report the service for image guidance performed as part of treatment delivery, not for creating the radiation dose plan or calculating dose. Documentation should identify the images acquired, the localization or positioning assessment, and the interpretation or resulting alignment decision. CMS recognizes professional and technical components: modifier 26 identifies interpretation, modifier TC identifies equipment and staff, and reporting without either modifier represents the global service. The CMS physician fee schedule separately prices both modifier components.
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 77387 pays more and less
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$34.13 to $48.14
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | $34.39 | Unavailable |
| Alaska* | $48.14 | Unavailable |
| Arizona | $35.87 | Unavailable |
| Arkansas | $34.13 | Unavailable |
| Atlanta | $36.88 | Unavailable |
| Austin | $37.07 | Unavailable |
| Bakersfield | $37.67 | Unavailable |
| Baltimore/Surr. Cntys | $37.93 | Unavailable |
| Beaumont | $35.19 | Unavailable |
| Brazoria | $36.25 | Unavailable |
| Chicago | $37.93 | Unavailable |
| Chico | $37.55 | Unavailable |
| Colorado | $37.27 | Unavailable |
| Connecticut | $38.05 | Unavailable |
| Dallas | $36.42 | Unavailable |
| Dc + Md/Va Suburbs | $40.01 | Unavailable |
| Delaware | $36.27 | Unavailable |
| Detroit | $36.65 | Unavailable |
| East St. Louis | $36.41 | Unavailable |
| El Centro | $37.55 | Unavailable |
| Fort Lauderdale | $37.38 | Unavailable |
| Fort Worth | $36.30 | Unavailable |
| Fresno | $37.55 | Unavailable |
| Galveston | $36.33 | Unavailable |
| Hanford-Corcoran | $37.55 | Unavailable |
| Hawaii, Guam | $37.72 | Unavailable |
| Houston | $36.88 | Unavailable |
| Idaho | $34.86 | Unavailable |
| Indiana | $34.97 | Unavailable |
| Iowa | $34.72 | Unavailable |
| Kansas | $34.69 | Unavailable |
| Kentucky | $34.91 | Unavailable |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | $39.32 | Unavailable |
| Madera | $37.55 | Unavailable |
| Manhattan | $40.50 | Unavailable |
| Merced | $37.55 | Unavailable |
| Metropolitan Boston | $39.69 | Unavailable |
| Metropolitan Kansas City | $35.61 | Unavailable |
| Metropolitan Philadelphia | $37.53 | Unavailable |
| Metropolitan St. Louis | $35.80 | Unavailable |
| Miami | $38.46 | Unavailable |
| Minnesota | $36.07 | Unavailable |
| Mississippi | $34.38 | Unavailable |
| Modesto | $37.55 | Unavailable |
| Montana** | $36.40 | Unavailable |
| Napa | $41.38 | Unavailable |
| Nebraska | $34.81 | Unavailable |
| Nevada** | $36.25 | Unavailable |
| New Hampshire | $36.80 | Unavailable |
| New Mexico | $35.55 | Unavailable |
| New Orleans | $35.79 | Unavailable |
| North Carolina | $35.19 | Unavailable |
| North Dakota** | $35.81 | Unavailable |
| Northern Nj | $39.94 | Unavailable |
| Nyc Suburbs/Long Island | $41.12 | Unavailable |
| Ohio | $35.31 | Unavailable |
| Oklahoma | $34.83 | Unavailable |
| Oxnard-Thousand Oaks-Ventura | $38.98 | Unavailable |
| Portland | $37.92 | Unavailable |
| Poughkpsie/N Nyc Suburbs | $38.85 | Unavailable |
| Puerto Rico | $36.53 | Unavailable |
| Queens | $40.61 | Unavailable |
| Redding | $37.55 | Unavailable |
| Rest Of California | $37.55 | Unavailable |
| Rest Of Florida | $36.35 | Unavailable |
| Rest Of Georgia | $35.23 | Unavailable |
| Rest Of Illinois | $35.87 | Unavailable |
| Rest Of Louisiana | $34.91 | Unavailable |
| Rest Of Maine | $35.01 | Unavailable |
| Rest Of Maryland | $36.70 | Unavailable |
| Rest Of Massachusetts | $37.24 | Unavailable |
| Rest Of Michigan | $35.43 | Unavailable |
| Rest Of Missouri | $34.63 | Unavailable |
| Rest Of New Jersey | $38.58 | Unavailable |
| Rest Of New York | $35.47 | Unavailable |
| Rest Of Oregon | $36.06 | Unavailable |
| Rest Of Pennsylvania | $35.31 | Unavailable |
| Rest Of Texas | $35.66 | Unavailable |
| Rest Of Washington | $37.14 | Unavailable |
| Rhode Island | $37.15 | Unavailable |
| Riverside-San Bernardino-Ontario | $37.89 | Unavailable |
| Sacramento-Roseville-Folsom | $38.83 | Unavailable |
| Salinas | $38.66 | Unavailable |
| San Diego-Chula Vista-Carlsbad | $39.12 | Unavailable |
| San Francisco-Oakland-Berkeley (Marin Cnty) | $43.23 | Unavailable |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | $43.19 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | $44.05 | Unavailable |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | $43.91 | Unavailable |
| San Luis Obispo-Paso Robles | $38.09 | Unavailable |
| Santa Cruz-Watsonville | $39.15 | Unavailable |
| Santa Maria-Santa Barbara | $38.68 | Unavailable |
| Santa Rosa-Petaluma | $39.52 | Unavailable |
| Seattle (King Cnty) | $40.24 | Unavailable |
| South Carolina | $35.29 | Unavailable |
| South Dakota** | $35.74 | Unavailable |
| Southern Maine | $35.92 | Unavailable |
| Stockton | $37.55 | Unavailable |
| Suburban Chicago | $37.68 | Unavailable |
| Tennessee | $34.79 | Unavailable |
| Utah | $35.54 | Unavailable |
| Vallejo | $41.33 | Unavailable |
| Vermont | $35.79 | Unavailable |
| Virgin Islands | $36.53 | Unavailable |
| Virginia | $35.90 | Unavailable |
| Visalia | $37.55 | Unavailable |
| West Virginia | $35.18 | Unavailable |
| Wisconsin | $35.18 | Unavailable |
| Wyoming** | $36.15 | Unavailable |
| Yuba City | $37.55 | Unavailable |
77387 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.
$34.13
$48.14
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 | $48.14 | 1 |
| AL | $34.39 | 1 |
| AR | $34.13 | 1 |
| AZ | $35.87 | 1 |
| CA | $37.55–$44.05 | 29 |
| CO | $37.27 | 1 |
| CT | $38.05 | 1 |
| DC | $40.01 | 1 |
| DE | $36.27 | 1 |
| FL | $36.35–$38.46 | 3 |
| GA | $35.23–$36.88 | 2 |
| GU | $37.72 | 1 |
| HI | $37.72 | 1 |
| IA | $34.72 | 1 |
| ID | $34.86 | 1 |
| IL | $35.87–$37.93 | 4 |
| IN | $34.97 | 1 |
| KS | $34.69 | 1 |
| KY | $34.91 | 1 |
| LA | $34.91–$35.79 | 2 |
| MA | $37.24–$39.69 | 2 |
| MD | $36.70–$40.01 | 3 |
| ME | $35.01–$35.92 | 2 |
| MI | $35.43–$36.65 | 2 |
| MN | $36.07 | 1 |
| MO | $34.63–$35.80 | 3 |
| MS | $34.38 | 1 |
| MT | $36.40 | 1 |
| NC | $35.19 | 1 |
| ND | $35.81 | 1 |
| NE | $34.81 | 1 |
| NH | $36.80 | 1 |
| NJ | $38.58–$39.94 | 2 |
| NM | $35.55 | 1 |
| NV | $36.25 | 1 |
| NY | $35.47–$41.12 | 5 |
| OH | $35.31 | 1 |
| OK | $34.83 | 1 |
| OR | $36.06–$37.92 | 2 |
| PA | $35.31–$37.53 | 2 |
| PR | $36.53 | 1 |
| RI | $37.15 | 1 |
| SC | $35.29 | 1 |
| SD | $35.74 | 1 |
| TN | $34.79 | 1 |
| TX | $35.19–$37.07 | 8 |
| UT | $35.54 | 1 |
| VA | $35.90–$40.01 | 2 |
| VI | $36.53 | 1 |
| VT | $35.79 | 1 |
| WA | $37.14–$40.24 | 2 |
| WI | $35.18 | 1 |
| WV | $35.18 | 1 |
| WY | $36.15 | 1 |
How the 77387 rate is calculated
Each of 77387’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 · 77387
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.68Practice expense 0.38Malpractice 0.03
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 77387
The CMS indicators that decide how 77387 is paid alongside other services.
CMS payment indicators · 77387
Radiation guidance
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
77387 without 26 · national office
$36.41
Radiation guidance
77387-26 · Professional component
$36.41
Pays only the interpretation and report.
77387 compared with similar codes
Compare codes
77387 vs 77301 vs 77300 vs 77417: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 77301IMRT planning
- 77301 covers planning for intensity-modulated radiation therapy. Use 77387 for image localization, tracking, or patient positioning during treatment delivery.
- 77300Dosimetry calculation
- 77300 is a radiation dose calculation service. It does not describe image acquisition and positioning guidance during treatment delivery.
- 77417Ther radiology port image(s)
- 77417 describes therapeutic radiology port films. 77387 is used for image guidance that supports localization, tracking, or positioning for treatment.
77387 billing questions
Is 77387 reported for each treatment image or each treatment session?
It describes image guidance for radiation delivery, including image acquisition and interpretation. Document the guidance service performed for the treatment session rather than treating each image as a separate service.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical service involving equipment and staff. Without either modifier, the claim represents the global service.
How is 77387 different from 77301?
77387 covers image-based localization and positioning during treatment delivery. 77301 is for planning an intensity-modulated radiation therapy course, not guidance performed during a treatment session.
Is image guidance included in the radiation treatment delivery service?
77387 identifies the image-guidance service separately from treatment delivery. The record should support that guidance was performed, with images acquired and interpreted as applicable to the components billed.
How does 77387 differ from portal imaging?
77387 describes image guidance used to localize, track, or position the patient for treatment. 77417 describes therapeutic radiology port films, a distinct imaging 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
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