CPT 77280Radiology

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CPT 77280 covers the planning and simulation phase for radiation therapy using simple field setups, where physicians map out the treatment area before actual radiation delivery begins.

Showing rates for

National Average

Base Medicare rate

$260.07

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

0.7

PE RVU (NF)

7.29

MP RVU

0.05

Total RVU

8.04

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

NCCI bundling edits

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Billing tips

Verify that simulation complexity matches code selection - 77280 is for simple fields only (typically 1-3 ports); upgrade to 77285 for intermediate complexity (3-4 ports) or 77295 for complex simulations
Impact: Undercoding loses $90-400 in reimbursement; overcoding risks audits and recoupment of the full $260.07 plus penalties
Document the number of treatment ports/fields, anatomical areas treated, and complexity factors in simulation report to support code selection
Impact: Missing field documentation is the #1 cause of downgrades from intermediate/complex to simple simulation, resulting in automatic payment reductions
Bill simulation on the date of service performed, not when treatment begins; simulation must precede treatment delivery codes (77401-77425)
Impact: Date of service errors trigger denials requiring appeals, delaying payment by 30-60 days on average
Do not bill 77280 with same-day treatment delivery codes on initial visit; simulation must be distinct service from treatment
Impact: Bundling edits will auto-deny the simulation charge, losing the $260.07 reimbursement entirely
For repeat simulations during treatment course, document specific medical necessity such as tumor response, anatomical changes, or treatment modification requirements
Impact: Lack of medical necessity documentation results in 80%+ denial rate on repeat simulations per Medicare audit data
Ensure physics consultation (77336) and dosimetry planning (77300, 77306-77307) are billed separately as these are not included in simulation codes
Failing to bill separately billable planning services leaves $200-800 in additional legitimate revenue uncaptured per case

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77280 in 2025?

The 2025 Medicare national average reimbursement for CPT 77280 is $260.07 for both facility and non-facility settings, based on 8.04 total RVUs and the 2025 conversion factor of 32.3465.

What is the difference between CPT 77280, 77285, and 77295?

CPT 77280 is for simple simulation (1-3 ports, straightforward geometry), 77285 is for intermediate complexity (3-4 ports, moderate complexity), and 77295 is for complex simulation (5+ ports, complex blocking, or special considerations). The complexity level is determined by number of treatment fields, anatomical areas, and technical difficulty.

Can CPT 77280 be billed on the same day as radiation treatment delivery?

Generally no, simulation should be performed and billed separately prior to treatment initiation. Billing 77280 on the same date as treatment delivery codes (77401-77425) typically triggers bundling edits unless the simulation represents a distinct session for a different treatment site with appropriate modifier documentation.

How many RVUs is CPT code 77280 worth?

CPT 77280 has 8.04 total RVUs in 2025, consisting of 0.7 work RVUs, 7.29 practice expense RVUs (both facility and non-facility), and 0.05 malpractice RVUs.

When can a repeat simulation with CPT 77280 be billed during a treatment course?

Repeat simulations are billable when medically necessary due to significant anatomical changes (weight loss/gain), tumor response requiring field modification, treatment plan revision, or equipment/technique changes. Documentation must clearly establish why the original simulation is no longer adequate, and modifier 76 or 77 should be appended.

What documentation is required to bill CPT 77280?

Required documentation includes patient positioning details, anatomical treatment area with landmarks, number and arrangement of ports/fields (must support simple complexity), field sizes and beam angles, treatment intent, and radiation oncologist signature. The simulation report must clearly demonstrate that complexity level is simple rather than intermediate or complex.

Who can perform and bill for radiation therapy simulation CPT 77280?

CPT 77280 must be performed by or under the direct supervision of a board-certified radiation oncologist. The service can be billed by radiation oncology physicians, hospital radiation oncology departments, or freestanding radiation therapy centers where qualified radiation oncologists oversee the simulation process.