CPT 77285Radiology

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CPT 77285 covers intermediate radiation therapy simulation, where imaging and planning tools are used to map out the exact area where cancer treatment radiation beams will be aimed. This planning session ensures radiation hits the tumor while avoiding healthy tissue.

Showing rates for

National Average

Base Medicare rate

$431.50

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

1.05

PE RVU (NF)

12.23

MP RVU

0.06

Total RVU

13.34

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

NCCI bundling edits

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Billing tips

Accurately distinguish intermediate (77285) from simple (77280) and complex (77290) simulations based on number of treatment areas and planning complexity
Impact: Correct code selection prevents $150-300 revenue loss or overpayment audit exposure; 77280 pays approximately $200 less while 77290 pays $200-300 more
Document all imaging modalities used during simulation (CT, fluoroscopy) and number of treatment fields/ports (2-4 for intermediate)
Impact: Reduces denial rate by 35-40%; lack of documentation is primary reason for downcoding from intermediate to simple simulation
Bill simulation codes only once per course of radiation therapy, not per treatment fraction
Impact: Prevents 100% denial and potential fraud investigation; simulation is preparatory service billed once regardless of treatment duration
Verify that simulation is billed before or on same date as treatment planning codes (77295, 77300, 77301) but after consultation
Impact: Ensures logical claim processing and reduces 15-20% of sequence-related denials; payers expect simulation before planning
When billing globally, do not append modifier 26 or TC; use modifiers only when services are split between professional and technical components
Impact: Maximizes reimbursement at full $431.50; inappropriate modifier use can reduce payment by 50-70%
Link simulation to appropriate cancer diagnosis codes (C00-D49) with laterality and site specificity
Impact: Reduces medical necessity denials by 25-30%; generic cancer codes trigger automated denials from most major payers

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77285 in 2025?

The 2025 Medicare national average reimbursement for CPT 77285 is $431.50 for both facility and non-facility settings. This rate is based on 13.34 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and MAC-specific adjustments.

What is the difference between CPT codes 77280, 77285, and 77290?

CPT 77280 is simple simulation (1 treatment area, basic setup), 77285 is intermediate simulation (2-4 treatment areas with 3D imaging and moderate complexity planning), and 77290 is complex simulation (5+ areas or highly complex anatomical targets requiring advanced imaging and planning). The distinction is based on number of treatment ports, imaging complexity, and planning requirements.

How many times can you bill CPT 77285 for the same patient?

CPT 77285 should be billed only once per course of radiation therapy for a specific treatment site. A new simulation can be billed if the patient receives treatment for a different site, experiences recurrence requiring new planning, or has significant anatomical changes necessitating complete re-simulation with new medical necessity documentation.

Can CPT 77285 be billed with treatment planning codes on the same day?

Yes, CPT 77285 can be billed with treatment planning codes (77295, 77300, 77301) on the same date as these are separate, sequential services in radiation therapy preparation. Simulation typically precedes planning and both are necessary components of radiation treatment setup. No modifier is usually required as these codes are not bundled by NCCI edits.

What documentation is required to support billing CPT 77285?

Required documentation includes a physician prescription, simulation report detailing imaging modality (typically CT), description of 2-4 treatment fields/ports, treatment volume definition, beam arrangements, immobilization devices used, archived simulation images, and physician signature. Documentation must clearly demonstrate intermediate complexity to prevent downcoding to 77280.

Do I need modifier 26 or TC when billing CPT 77285?

Use modifier 26 (professional component) only when billing for physician supervision and interpretation without owning equipment. Use modifier TC (technical component) when the facility bills for equipment and technologist services separately. If providing both professional and technical services, bill 77285 without modifiers to receive the full $431.50 reimbursement.

What are the work RVUs for CPT code 77285?

CPT 77285 has 1.05 work RVUs, 12.23 practice expense RVUs (both facility and non-facility), and 0.06 malpractice RVUs, totaling 13.34 RVUs for 2025. These values reflect the physician work, overhead costs, and liability associated with intermediate radiation therapy simulation services.