Module 2 of the Radiation Oncology RCM Masterclass compares the completed service with the proposed claim, so documented facts, not templates, drive codes and modifiers.
This radiation oncology claim review training walks billing staff through E/M and treatment management, modifiers 25, 26, and TC, the 2026 conventional delivery levels, and a repeatable daily prebill audit.
Learning objectives
By the end of this module, you will be able to:
Distinguish the 2026 delivery levels 77402, 77407, and 77412 by documented delivery characteristics.
Decide when an E/M service is separately reportable from routine treatment management, based on the documented work and the payer rules.
Apply modifiers 25, 26, and TC only when their requirements are met, and check the payer rule for 77387.
Run the six-step daily prebill audit before claims are released.
Key points from this radiation oncology claim review training
Lesson 2.1: E/M and treatment management
The label “consult” does not determine the claim code. Review setting, patient status, documentation, and payer rules.
For Medicare, NCCI permits the initial E/M at which the treatment decision is made and restricts separate E/M reporting with radiation oncology services, with specified exceptions.
A routine on-treatment assessment should not automatically generate an additional office E/M, and modifier 25 should not be added just to clear an edit.
A new diagnosis alone does not establish a new patient.
Lesson 2.2: Modifiers 25, 26, and TC
Modifier 25 describes a significant, separately identifiable E/M on the same day; it does not make routine treatment management separately billable.
Modifiers 26 and TC apply only when the code permits component billing. Check the code’s component status and payer requirements.
For 2026 conventional delivery, technical image guidance is included in delivery payment, and 77387 represents the professional image-guidance service.
ASTRO documented inconsistent 77387 modifier processing across payers early in 2026. Verify the specific payer product’s written rule and limit any fix to that scope.
Coding lab: 2026 conventional delivery levels
77402, 77407, and 77412 are the three 2026 conventional delivery levels; level depends on documented delivery characteristics.
IMRT or VMAT alone does not establish level 3. Confirm the full current descriptor before selection.
An abbreviation such as “DIBH” alone does not establish active motion management details; request the clinical description.
SRS, SBRT, brachytherapy, proton, radiopharmaceutical, and superficial treatment follow their own rules.
Lesson 2.3: The daily prebill audit
Reconcile performed services to charges, in both directions.
Validate demographics, coverage order, provider identifiers, location, and claim type, and match the authorization to codes, quantities, dates, provider, and site.
Confirm documentation, code-year validity, diagnosis linkage, units, modifiers, and claim history before release.
Never move a service to another date to avoid an edit. The service record determines the date.
Guided practice cases include an automatic weekly E/M charge, a modifier rejection on 77387, IMRT proposed as level 3, DIBH as the only detail, and three exceptions in one batch.
Watch and download
Runtime 18:20. Captions are available in the player.
Independent training. Completion does not confer a coding credential or approved continuing education credit.
Fictional examples. All names, quantities, deadlines, and amounts in the cases are fictional.
Scope. The examples focus on external beam workflows. Specialized modalities need their own detailed coding review.
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