Image Guided Radiation Therapy (IGRT) has become a critical component of modern radiation oncology, helping clinicians improve treatment accuracy while minimizing radiation exposure to surrounding healthy tissue. As technology and treatment delivery methods have evolved, coding and reimbursement policies have also changed. One of the most significant recent developments is the bundling of the technical component of image guidance into radiation treatment delivery codes and the consolidation of professional image guidance reporting under CPT code 77387.
Image Guided Radiation Therapy (IGRT) uses advanced imaging technologies such as cone beam CT, stereoscopic X ray imaging, ultrasound, and MRI guidance to verify patient positioning and target localization before or during radiation treatment. By confirming the exact location of the treatment area, IGRT helps ensure that radiation is delivered accurately, particularly when treating tumors that may move due to breathing, organ motion, or daily variations in patient positioning.
The use of IGRT has become standard practice for many radiation therapy procedures because it improves precision and supports better clinical outcomes.
Historically, providers could report both the technical and professional components of image guidance services separately. Various CPT and HCPCS codes were used depending on the imaging modality and payer requirements.
Beginning in 2026, Medicare implemented significant coding changes that simplified the reporting of image guidance services. Multiple image guidance codes were eliminated and consolidated into a single CPT code, 77387. At the same time, the technical component of image guidance became bundled into radiation treatment delivery services and is no longer separately reimbursable.
This means that the costs associated with acquiring and performing image guidance are now considered part of the overall treatment delivery process rather than a standalone billable service.
CPT code 77387 is defined as:
“Guidance for localization of target volume for delivery of radiation treatment delivery, including intrafraction tracking, when performed.”
The code encompasses multiple image guidance modalities, including:
Cone beam CT guidance
CT based image guidance
MRI based image guidance
Ultrasound guidance
Stereoscopic image guidance
Intrafraction tracking technologies
Under the current Medicare framework, CPT code 77387 is used to report the physician’s professional work associated with reviewing, interpreting, and approving image guidance necessary for treatment localization.
The bundling of technical image guidance services means that providers can no longer bill separately for the technical portion of IGRT when delivering radiation treatment. Instead, reimbursement for those technical activities is included within the radiation treatment delivery codes.
From a billing perspective, this change simplifies reporting but also requires practices to ensure that their charge capture systems, workflows, and documentation processes accurately reflect the updated coding structure.
Although the technical component is bundled, physician review and interpretation of image guidance remain separately reportable through the professional component of CPT code 77387 when supported by appropriate documentation.
Despite the coding simplification, proper documentation remains essential. Radiation oncologists should continue documenting their review and approval of imaging data before treatment delivery. Electronic approval of images and shifts or documentation within the patient’s medical record may support the professional service reported under CPT code 77387.
Accurate documentation helps ensure compliance, supports medical necessity, and reduces the risk of audits or claim denials.
The transition to bundled image guidance reimbursement reflects a broader industry trend toward integrating advanced technologies into comprehensive treatment delivery services. While the changes may reduce separate reimbursement opportunities for technical image guidance, they also create a more streamlined coding structure that aligns with modern radiation therapy workflows.
Radiation oncology practices should review their billing policies, educate staff on the updated requirements, and verify that documentation supports the professional services associated with CPT code 77387. Staying informed about these changes can help practices maintain compliance and optimize revenue cycle performance.
As radiation oncology continues to advance, coding and reimbursement policies will continue evolving alongside clinical practice. Understanding the relationship between treatment delivery codes and image guidance services is essential for accurate billing and revenue integrity.
By recognizing that technical IGRT services are now bundled into treatment delivery codes while professional image guidance is reported through CPT code 77387, providers can better navigate the current reimbursement landscape and focus on delivering high quality patient care.