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Billing code 77469: IORT managementMedicare rate & RVUs

Reports physician management of intraoperative radiation treatment delivered during surgery, distinct from the separate code for delivering the radiation beam.

CMS RVU26DEffective Oct 1, 2026109 payment localities354 Medicare services in 2024

Medicare pays $266.54 for 77469 nationally in a facility.

Medicare rate · 77469

IORT management

Swap in your local Medicare rate.

Work RVUs
5.61
Total RVUs
7.98
Global days
XXX

National rate · 2026

$266.54

Facility setting, before claim adjustments.

See every locality for 77469 → · 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
  1. Medicare rate
  2. What 77469 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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 fee schedule data 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

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

109 of 109 payment localities

77469 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$252.10
Alaska*Unavailable$357.82
ArizonaUnavailable$262.42
ArkansasUnavailable$250.32
AtlantaUnavailable$271.09
AustinUnavailable$268.98
BakersfieldUnavailable$270.54
Baltimore/Surr. CntysUnavailable$277.73
BeaumontUnavailable$259.69
BrazoriaUnavailable$264.22

77469 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.

View every state and territory as a table
77469 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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.

How the rate is built · 77469

RVUs × geographic indexes × conversion factor

Swap in your local Medicare rate.

Work 5.61Practice expense 1.93Malpractice 0.44

7.9800 adjusted RVUs×$33.4009 conversion factor=$266.54

All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.

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.

Place of service · 77469

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

Non-facility (office) rate · national

—

77469 isn’t priced in this setting.

77469 compared with similar codes

Compare codes

77469 vs 77424 vs 77425 vs 77427 vs 77470: national Medicare rates

Swap in your local Medicare rate.

  • 77469
    IORT management · 5.61 wRVU
    —
  • 77424
    · 0 wRVU
    —
  • 77425
    · 0 wRVU
    —
  • 77427
    Radiation treatment management · 3.37 wRVU
    $195.40
  • 77470
    Special radiation · 1.98 wRVU
    $144.96

How to choose

77424Io rad tx delivery by x-ray
77424 represents intraoperative radiation delivery by x-ray. Use 77469 for the physician’s management service, not as a substitute for the delivery code.
77425Io rad tx deliver by elctrns
77425 represents intraoperative radiation delivery by electrons. It identifies the delivery modality, while 77469 represents management.
77427Radiation treatment management
77427 is radiation treatment management counted in groups of five treatments. 77469 is specific to management of treatment delivered during surgery.
77470Special radiation
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.

Codes related to 77469
CodeHow it relatesNational office range
Often billed with
77424Io rad tx delivery by x-rayIntraoperative x-ray radiation delivery; describes beam delivery rather than physician management.No office rate
77425Io rad tx deliver by elctrnsIntraoperative electron radiation delivery; describes beam delivery rather than physician management.No office rate
Used instead
77427Radiation treatment managementManagement for a conventional radiation course counted in groups of five treatments.$180.73–$252.60
77431Radiation managementRadiation therapy management for a limited treatment course rather than intraoperative treatment.$98.21–$136.64
77435SBRT managementManagement of stereotactic body radiation therapy, not radiation delivered during surgery.$594.79–$835.29

77469 billing questions

Is 77469 the code for delivering the intraoperative radiation beam?

No. It reports the physician’s management of intraoperative radiation treatment. The x-ray or electron delivery is represented by its modality-specific delivery code when applicable.

Can 77469 be reported with an intraoperative radiation delivery code?

They describe different services: physician management and radiation delivery. The record should support the management work separately from the delivery.

How is 77469 different from 77427?

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

What documentation supports 77469?

Document the intraoperative radiation treatment, the physician’s management involvement, and how the service relates to the operative treatment and beam delivery.

Does 77469 identify x-ray or electron treatment?

No. The management code does not specify the delivery modality. The applicable delivery code distinguishes intraoperative x-ray treatment from electron treatment.

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 77469PPRRVU2026_Oct_nonQPP.csv, line 9,116 (RVU26D)

Open CMS sourceHow we calculate rates

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