CPT 77262Radiology

Ther radiology tx plng intrm

CPT code 77262 covers intermediate-level radiation therapy treatment planning, which involves creating a customized radiation treatment plan for cancer patients requiring moderate complexity dosimetry calculations and field arrangements.

Showing rates for

National Average

Base Medicare rate

$106.10

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

PE RVU (NF)

1.15

MP RVU

0.13

Total RVU

3.28

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

NCCI bundling edits

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Billing tips

Document the specific number of treatment areas (must be 3 or more for intermediate planning) and custom blocking requirements in the treatment planning directive
Impact: Prevents downcoding to 77261 (simple planning) which reimburses approximately $50-60 less per case
Bill 77262 only once per treatment course regardless of number of treatment planning sessions; subsequent modifications should be billed separately using appropriate codes
Impact: Avoid denials for duplicate billing; Medicare and most payers allow only one treatment planning code per course of therapy
Ensure dosimetry calculations and isodose distribution documentation are in the medical record before claim submission
Impact: Missing dosimetry documentation is the leading cause of audits; complete records reduce audit risk by approximately 70%
Verify payer-specific policies on splitting professional and technical components; some commercial payers do not recognize modifiers 26/TC for this code
Impact: Improper component billing can result in 100% denial or overpayment recovery of $40-60 per claim
When billing with simulation codes (77280-77295), ensure both services are performed and documented on different dates or clearly distinct sessions
Impact: Same-day billing without modifier 59 may trigger NCCI edits resulting in bundling and loss of $106.10 planning fee
For re-planning during treatment course, determine whether changes constitute new planning (77262 with modifier 76) or treatment management (77427/77431)
Impact: Incorrect code selection can result in denial or underpayment of $50-100 per service

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Frequently asked questions

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

77261 is simple planning (1-2 parallel opposed ports), 77262 is intermediate planning (3+ treatment areas with custom blocking), and 77263 is complex planning requiring highly complex blocking, rotational/special beam arrangements, or tissue compensators. The 2025 Medicare reimbursement for 77262 is $106.10, positioned between simple ($61-70) and complex ($185-205) planning rates.

How much does Medicare pay for CPT code 77262 in 2025?

Medicare pays $106.10 for CPT 77262 in 2025 based on the national average non-facility rate. This represents 3.28 total RVUs (2.0 work RVU, 1.15 practice expense RVU, 0.13 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can CPT 77262 be billed more than once per patient?

Generally, 77262 should only be billed once per treatment course. If re-planning is medically necessary due to disease progression, change in treatment site, or change in modality, it may be billed again with modifier 76 (same physician) or 77 (different physician), but requires clear documentation justifying the medical necessity for a new treatment plan.

What modifiers are commonly used with CPT 77262?

Common modifiers include 26 (professional component only), TC (technical component only) for splitting components in hospital settings, 76/77 for repeat planning when medically necessary, and 59/XU for distinct procedural services when planning multiple separate treatment courses on the same date.

What documentation is required to bill CPT 77262?

Required documentation includes cancer diagnosis, treatment planning directive, dosimetry calculations for 3+ treatment areas, isodose distributions, custom blocking specifications, treatment volume determination, selected modality and energy with rationale, fractionation scheme, and radiation oncologist's review and approval signature.

Can 77262 be billed with radiation therapy simulation codes on the same day?

Yes, but modifier 59 or XU is typically required to prevent NCCI bundling edits when 77262 is billed with simulation codes (77280-77295) on the same date. Documentation should clearly show these were distinct sessions or services, ideally performed at different times during the day.

What are the RVUs for CPT code 77262 in 2025?

CPT 77262 has 3.28 total RVUs in 2025, consisting of 2.0 work RVUs, 1.15 practice expense RVUs (both facility and non-facility), and 0.13 malpractice RVUs. Both facility and non-facility rates are identical at $106.10 nationally.