CPT 77306Radiology

Telethx isodose plan simple

CPT 77306 covers the creation of a simple treatment plan for radiation therapy, where physicians map out radiation dose distribution to target cancer while protecting healthy tissue.

Showing rates for

National Average

Base Medicare rate

$145.56

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

1.4

PE RVU (NF)

3.03

MP RVU

0.07

Total RVU

4.5

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

NCCI bundling edits

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Billing tips

Document complexity justification meticulously to distinguish simple (77306) from intermediate (77307) planning to avoid downcoding
Impact: Prevents $60-80 loss per case from inappropriate downcoding when documentation fails to support level billed
Bill 77306 only once per treatment course regardless of number of fractions planned, as this is a per-plan code not per-treatment
Impact: Prevents 100% denial and potential fraud allegations from duplicate billing across fraction deliveries
Verify that treatment simulation (77280-77295) and treatment planning (77306) are billed as separate services with appropriate documentation
Impact: Maximizes reimbursement by capturing both simulation ($100-300) and planning ($145.56) when independently performed and documented
For facility billing, ensure 77306 is billed under revenue code 0409 or 0349 to properly categorize radiation oncology planning services
Impact: Improves clean claim rate and reduces processing delays that can extend A/R by 15-30 days
Document the number of ports, treatment areas, and dosimetry calculations performed to create audit trail supporting simple complexity level
Impact: Reduces audit vulnerability and supports medical necessity during retrospective reviews or CERT audits
When treatment plan changes mid-course, append modifier 76 and document clinical rationale for replanning to justify additional 77306 billing
Impact: Recovers additional $145.56 for legitimate replanning scenarios that would otherwise be denied as duplicates

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 77306 in 2025?

The 2025 Medicare national average reimbursement for CPT 77306 is $145.56 for both facility and non-facility settings. This rate is based on 4.5 total RVUs multiplied by the 2025 conversion factor of $32.3465.

How many times can you bill CPT 77306 for a single patient?

CPT 77306 is typically billed once per treatment course. Additional billing requires modifier 76 (repeat by same physician) or 77 (repeat by different physician) with documentation justifying why a new treatment plan was medically necessary, such as tumor progression, anatomical changes, or significant treatment modification.

What is the difference between CPT 77306 and 77307?

CPT 77306 covers simple teletherapy planning (1-2 parallel opposed ports, basic dosimetry, single treatment area), while 77307 represents intermediate planning (3+ treatment areas or complex blocking). The complexity difference typically results in $60-100 higher reimbursement for 77307, making proper documentation of planning complexity critical.

Can CPT 77306 be billed with simulation codes on the same day?

Yes, treatment simulation codes (77280-77295) and planning code 77306 are separately billable when performed as distinct services. Simulation involves patient positioning and imaging, while planning involves dosimetry calculations and treatment design. Both must be independently documented to avoid bundling denials.

What RVU values apply to CPT 77306 in 2025?

CPT 77306 has a work RVU of 1.4, non-facility PE RVU of 3.03, facility PE RVU of 3.03, and malpractice RVU of 0.07, totaling 4.5 RVUs. Both facility and non-facility PE RVUs are identical at 3.03 for this code.

Does CPT 77306 require a professional component modifier?

Modifier 26 (professional component) should be appended when the physician provides only supervision and interpretation without owning the planning equipment. Modifier TC (technical component) applies when billing only for equipment and staff. Without modifiers, the code represents the global service including both components.

What documentation is needed to justify CPT 77306 medical necessity?

Required documentation includes physician orders for radiation planning, treatment site identification, beam arrangement showing 1-2 ports, isodose calculations, dose prescription, physician review/approval, and confirmation of simple complexity criteria. Documentation must link the radiation treatment to a covered diagnosis and demonstrate why treatment planning was medically necessary.