Background:

As the inventors of, and market leaders in Surface Guided Radiation Therapy (SGRT), Vision RT has been working to increase awareness of the clinical benefits of surface guidance with the Centers for Medicare & Medicaid Services (CMS), the American Medical Association (AMA) and ASTRO.

As written, the 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule, published on July 14th, 2025, indicates that “active motion management” (a functionality of SGRT) would qualify treatment as Level 3, billed with CPT 77412.

CPT 77412 is the most advanced of the three new radiation therapy codes listed, with potentially higher reimbursement per fraction.

Proposed image guidance code updates:

On the professional side, image guidance will no longer be separately reported for any technical billing. The physician billing the professional component in either a hospital or freestanding site of service can now report CPT 77387-26 for any surface guidance.

 

Watch the Expert-Led Webinar

Vision RT recently hosted a free webinar on the Proposed Rule for the 2026 Medicare Physician Fee Schedule (MPFS).

The webinar featured Sally Eggleston, a radiation oncology consulting and billing expert from Radiation Business Solutions, giving an overview of the proposed changes and details on how to maximize SGRT reimbursements.

There were also comments from Vision RT’s Ben Waghorn, Ph.D. DABR, who introduced OIS Reports, a new (and very timely, considering this proposed rule) module that automates SGRT documentation tasks. Directly integrated into AlignRT, OIS Reports will help make auditing and billing processes faster, easier and less prone to human error.



The Opportunity:

The proposed new code would likely make treatments using SGRT reimbursable at a higher rate for free-standing centers. This would support clinics in adopting SGRT, a patient-centric technology with established clinical benefits. It would also help patients by enabling access to tattooless treatments, open-face masks for SRS, and shorter treatment times – all of which enhance comfort and well-being.

To assist clinics with billing, Vision RT’s new OIS Reports module is now available. With OIS Reports, SGRT records are integrated to streamline reporting and billing processes.

How to Show Your Support:

Vision RT is asking the radiation therapy community to support this proposal, as drafted, by commenting on the proposed rule.

You can read the proposal and submit your comments here.

Public comment ends Sep 12, 2025 at 11:59 PM EDT.

FAQs on the Proposal

Here is an excerpt from the proposed new coding:

77402
77407
77412
Level 1 (eg, single electron field, multiple electron fields, or 2D photons). Including imaging guidance, when performed
Level 2 single isocenter (eg, 3D or IMRT), photons, including imaging guidance, when performed
Level 3 multiple isocenters with photon therapy (eg, 2D, 3D, or IMRT) OR a single isocenter photon therapy (eg, 3D or IMRT) with active motion management, OR total skin electrons, OR electron/photon field(s), including imaging guidance, when performed

 

 

With 24 years of experience, we are uniquely placed to support clinics looking to implement SGRT into their workflow, as well as those looking to expand their current utilization of this technology. We offer best-in-class service and support from your first steps, all the way to go-live, and beyond.

To assist clinics with billing and tracking their return on investment, Vision RT’s new OIS Reports Module is now available. With OIS Reports, SGRT records are automatically integrated, to streamline reporting and billing processes.

Vision RT also partners with Radiation Business Solutions, a revenue cycle company, to provide you with 1:1 consults to help you maximize your SGRT reimbursement opportunity.

To request a Proforma AlignRT SGRT Analysis Summary with Radiation Business Solutions, contact your Regional Sales Manager or Clinical Applications Specialist. 

 

 

When the 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule is officially announced, there will be a link to post comments on the proposal. We will place that link here and we encourage members of the radiation oncology community to support this proposal, as drafted, by commenting on the proposed rule.

 

 

Find out more about Vision RT and AlignRT

 

Vision RT is uniquely qualified to help your clinic if you are looking to adopt SGRT or expand your usage. We have more than 3,000 systems in active clinical use around the world, including in 24 of the top 25 US hospitals for cancer*.

AlignRT is at the center of Vision RT’s Surface Guided Radiation Therapy (SGRT) solutions. It’s a system that tracks a patient’s position before and during radiation therapy, to aid in setup and treatment accuracy and can help reduce treatment times by an average of 22% per fraction.1-7

SGRT is all we do

Not all SGRT systems are the same. When you choose Vision RT, you’re choosing market-leading solutions from a company with 24 years of expertise in radiotherapy innovation. We understand the challenges and the opportunities of implementing a new system and new workflows. Get in touch with us, and we’ll help you every step of the way. With Vision RT’s new OIS Reports Module, the SGRT documentation process can be automated, to ensure accurate and efficient data entry for end-of-treatment audits. This will help clinics to more easily process reimbursements, and increase their revenue.

 

  1. Giantsoudi PhD, et al. Tattoo Free Set-up for Breast Cancer Patients Receiving Regional Nodal Irradiation, Practical Radiation Oncology (2022) doi.org/10.1016/j.prro.2022.08.001
  2. Mueller et al. Accuracy and Efficiency of Patient Setup Using Surface Imaging versus Skin Tattoos for Accelerated Partial Breast Irradiation (2023) doi.org/10.1016/j.adro.2023.101183
  3. Sauer, TO. et al. Prerequisites for the clinical implementation of a markerless SGRT-only workflow for the treatment of breast cancer patients. Strahlenther Onkol 199, 22–29 (2023) doi.org/10.1007/s00066-022-01966-7
  4. Wei et al. Quantifying the impact of optical surface guidance in the treatment of cancers of the head and neck. J Appl Clin Med Phys, 21 (2020), pp. 73-82 doi.org/10.1002/acm2.12867
  5. Hickey et al. Surface Guided Radiotherapy (SGRT) vs Varian RPM for deep inspiration breath-hold (DIBH) breast treatments (2021) doi.org/10.1016/j.ejmp.2021.01.021
  6. Kang, S., Jin, H., Chang, J.H. et al. Evaluation of initial patient setup methods for breast cancer between surface-guided radiation therapy and laser alignment based on skin marking in the Halcyon system. Radiat Oncol 18, 60 (2023) doi.org/10.1186/s13014-023-02250-3
  7. Flores-Martinez et al. Assessment of the use of different imaging and delivery techniques for cranial treatments on the halcyon linac. J Appl Clin Med Phys (2020) 21:53–61 doi.org/10.1002/acm2.12772

Get in touch

Ready to take the next step?

Vision RT’s family of SGRT solutions guide radiation therapy for better patient care at every step: Sim, Planning, Treatment and Dose. Whether you’re looking for a quote, a product demo (virtual or in-person) or just more information, please get in touch.