IMRT not authorized
eviCore or the plan approved 3D and the course was delivered as IMRT, or the authorization expired mid-course. Core MB verifies modality, fraction count and dates before the first fraction and extends authorizations as needed.
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Radiation oncology medical billing services
Radiation oncology billing follows a course of treatment from consult through planning, simulation, dosimetry, daily delivery and weekly management. Every step has its own code and its own documentation requirement, and the delivery codes changed in 2026. Claims pay when planning documents are signed, fractions are counted correctly and authorizations cover the modality actually delivered.
What makes radiation oncology billing different
A single course of radiation generates dozens of claims across several months, and each one depends on the paperwork behind the one before it.
- Treatment delivery is now reported with 77402, 77407 and 77412 by complexity level with image guidance included in the technical payment; 77385, 77386, 77014 and the old delivery G-codes were deleted for 2026, and 77387 is professional-only.
- Planning and simulation use 77263 for complex treatment planning, 77280 through 77290 for simulation, 77295 for 3D planning, 77301 for IMRT planning and 77338 for multi-leaf collimator devices, each billed once per course unless a replan is documented.
- Treatment management under 77427 is billed per five fractions with the physician's weekly note, port film review and dose check, while 77431 covers one or two fraction courses and 77435 covers SBRT management, never stacked with 77427.
- Physics and dosimetry codes 77300, 77336 and 77370 require physicist signatures and dates, and 77336 is limited to one per five fractions, so a course with a mid-treatment boost needs documentation that shows why an extra charge applies.
Denials we see most in radiation oncology
Every denial gets a root cause, a fix and a feedback loop, so the same denial stops coming back.
Management units exceed fractions
77427 was billed more times than the fraction count supports. Core MB reconciles the treatment record against delivery claims weekly and bills management only when the fifth fraction or the course end is documented.
Deleted code billed
A 77385, 77386 or 77014 line hit the payer after the 2026 code changes and rejected. Core MB updated charge masters and scrubber edits for the new 77402, 77407 and 77412 levels per payer crosswalk.
How Core MB bills for radiation oncology
Core MB bills radiation oncology practices by course, with a biller who holds the authorization, the signed plan and the fraction log together so every delivery and management claim is supported. Credentialing for new radiation oncologists and physicists runs in the same client portal. Credentialing for new providers runs in the same system, tracked live in your client portal.
- Authorization tracking records modality, fraction count and date range, and triggers an extension request when any of them changes.
- Delivery charges are checked against the treatment record daily so missed or duplicate fractions are caught before the claim leaves.
- Weekly management claims are released only when the physician note, image review and dose verification are all signed.
Everything in the service
Core MB handles verification, authorizations, coding review, scrubbing, follow-up, denials, posting, AR, patient statements and reporting for radiation oncology, with credentialing in the same portal.
- Insurance verification and eligibility checks
- Charge entry and specialty-specific coding review
- Claim scrubbing and electronic submission
- Payer follow-up on every open claim
- Denial management and appeals
- Payment posting and reconciliation
- Accounts receivable recovery
- Patient statements and balance support
- Monthly reporting you can read in five minutes
- Provider credentialing and payer enrollment
Radiation oncology billing questions
How did the 2026 radiation oncology code changes affect our claims?
The IMRT delivery codes 77385 and 77386 and the CT guidance code 77014 were deleted along with the delivery G-codes. Delivery is now reported with 77402, 77407 and 77412 by complexity, with imaging bundled into the technical payment, and 77387 is professional-only for image guidance. Core MB rebuilt charge capture and scrubber rules for the new structure.
Why does eviCore keep denying our SBRT and proton requests?
Those modalities have the tightest medical policy criteria, and requests fail when the note does not cite the specific indication, histology and prior treatment the policy lists. Core MB builds authorization requests from the consult and planning notes with the policy criteria addressed directly, and handles peer-to-peer scheduling when the request is pended.
A patient stopped treatment after eight fractions. What can we bill?
Delivery is billed for the eight fractions actually given. Management under 77427 is billed once for the first five fractions and once more for the remaining three, since the code allows a final unit for three or more fractions at the end of a course. Core MB documents the early termination so the second unit is supported.
How do we get started with Core MB for radiation oncology billing?
Fill out the quote form with your sites, modalities and payer mix. We review current claims and authorization workflow, then set a start date, and the transition runs alongside your current billing so no course in progress is affected. Credentialing for new physicians and physicists can start at the same time.
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Radiation oncology billing built around the full course of treatment
Core MB keeps planning, delivery and management claims in sync with authorizations and the treatment record, so radiation oncology practices get paid for every fraction they deliver.