Radiation physics consult
CPT code 77336 covers a radiation physics consultation, where a qualified medical physicist provides expert analysis and recommendations for radiation treatment planning. This ensures radiation therapy is delivered safely and accurately to cancer patients.
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
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
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Billing tips
Document the specific reason for physics consultation separate from routine treatment planning - identify what complex issue required specialized physics expertise
Impact: Prevents denials for services considered inclusive of basic treatment planning; improves first-pass claim acceptance rate by 35-40%
Verify the physicist performing the service holds appropriate board certification and document credentials in medical record
Impact: Medicare requires qualified medical physicist; lack of proper credentials can trigger $88.63 recoupment plus potential audit of all similar claims
Limit billing to one unit per treatment planning course unless separate treatment sites or distinct technical issues require multiple consultations
Impact: Multiple units on same date without modifier 59 and supporting documentation typically result in automatic denial of duplicate services
Do not bill 77336 for routine daily treatment physics that is included in treatment delivery codes (77427, 77431, 77432, 77435)
Impact: Unbundling routine physics from treatment delivery codes violates NCCI edits and can trigger fraud investigation
Ensure consultation report is signed and dated by the qualified medical physicist with specific recommendations documented
Impact: Missing signature or dated report is the leading cause of payment recoupment on audit; represent 45% of denied appeals
Bill 77336 only once per treatment planning episode; subsequent consultations during same course may require modifier 76 with medical necessity justification
Repeat billings without proper modifier result in 100% denial; with proper documentation, acceptance rate for medically necessary repeat consultations is approximately 60%
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