CPT 77261Radiology

Ther radiology tx plng smpl

CPT 77261 covers simple radiation therapy treatment planning, which is the basic planning process a radiation oncologist performs before starting radiation treatment for cancer or other conditions requiring radiation.

Showing rates for

National Average

Base Medicare rate

$68.57

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

1.3

PE RVU (NF)

0.76

MP RVU

0.06

Total RVU

2.12

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Clearly document the complexity level criteria to justify simple vs intermediate vs complex planning codes
Impact: Incorrect complexity level selection can result in $68.57 underpayment (if 77261 used instead of 77262) or denial/downcoding if complexity documentation doesn't support higher levels
Bill 77261 only once per treatment course, not per fraction or per treatment session
Impact: Duplicate billing attempts result in 100% denial of subsequent claims and potential audit flags for fraudulent billing patterns
Ensure treatment planning occurs before radiation delivery (77402-77417 codes) and document the date of planning completion
Impact: Planning billed after or same date as treatment delivery may be denied for incorrect sequencing, resulting in $68.57 loss per claim
Do not bill 77261 with simulation codes (77280-77295) on different dates; verify payer policy on same-date bundling
Impact: Many payers bundle simulation into planning; unbundling can trigger denials or recoupment of $68.57 plus potential prepayment review
Use modifier 26 in hospital outpatient settings where the facility owns equipment and bills technical component separately
Impact: Missing modifier 26 in split-billing scenarios can cause claim rejection or overpayment recoupment; proper modifier use ensures accurate $68.57 professional component payment
Link appropriate ICD-10 diagnosis codes documenting medical necessity for radiation therapy
Impact: Missing or non-specific cancer diagnosis codes trigger medical necessity denials, delaying or preventing the $68.57 reimbursement

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77261 in 2025?

The 2025 Medicare national average reimbursement rate for CPT 77261 is $68.57 for both facility and non-facility settings, based on 2.12 total RVUs and the conversion factor of 32.3465.

How many RVUs is CPT code 77261 worth?

CPT 77261 has 2.12 total RVUs for 2025, consisting of 1.3 work RVUs, 0.76 practice expense RVUs, and 0.06 malpractice RVUs.

What is the difference between CPT 77261, 77262, and 77263?

CPT 77261 is for simple planning (1-2 ports, single area), 77262 is for intermediate planning (3+ ports or 2+ separate areas with custom blocking), and 77263 is for complex planning involving highly complex blocking, rotational/special beams, or tissue heterogeneity corrections.

Can CPT 77261 be billed more than once per patient?

CPT 77261 can be billed once per treatment course. If a patient requires a new treatment course for a different site or diagnosis, or if significant replanning is medically necessary due to clinical changes, 77261 may be billed again with appropriate documentation.

Do I need modifier 26 when billing CPT 77261?

Use modifier 26 when billing only the professional component in settings where you don't own the equipment and the facility bills the technical component separately, such as hospital outpatient departments. Omit modifier 26 when billing global services in physician-owned facilities.

Can CPT 77261 be billed with simulation codes on the same day?

Payer policies vary; Medicare and many commercial payers bundle simulation (77280-77295) with planning codes when performed on the same date. Check specific payer guidelines and consider spacing services across different dates when medically appropriate and properly documented.

What diagnosis codes are required for CPT 77261 medical necessity?

CPT 77261 requires a diagnosis code supporting the need for radiation therapy, typically malignant neoplasm codes (C00-C96 series) or specific benign conditions requiring radiation treatment. The diagnosis must clearly establish medical necessity for therapeutic radiation planning.