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    v1.0.30
    OpenPayerBilling CodesClinical Treatment Planning (External and Internal Sources) for Radiation TreatmentCPT cpt-77261-radiation-treatment-planning-initial
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    CPT 77261: Radiation Treatment Planning, Simple

    Medicare pays $72 and commercial payers pay $100 on average nationally for this procedure.

    CPT code 77261 describes clinical treatment planning for radiation therapy (simple complexity) in which the provider determines beam entry points, port locations, shielding block design, and therapy modes (single or combined); service type: treatment planning for radiation therapy; typical site of service: radiation oncology clinic or hospital outpatient radiation department.

    For related coverage guidance, see recent payer policy updates: Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policy, Inhaled Nitric Oxide Therapy (for New Mexico Only), Inhaled Nitric Oxide Therapy (for North Carolina Only).

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    National Reimbursement Benchmarks

    Nationally, Medicare’s mean rate of $71.8 for CPT 77261 sits below the average commercial aggregator BUCA’s mean of $99.7, creating a headline gap of $27.9 between federal and commercial averages. This gap indicates that commercially negotiated reimbursements are materially higher than Medicare for this service; median comparisons are available for many commercial plans but Medicare’s central tendency is represented by its $71 median, which aligns closely with its mean.

    Dispersion varies across payers: Blue Cross Blue Shield has a P75–P25 spread of $39.3, UnitedHealth Group $57.8, Cigna $66.3, Aetna $33.0, and BUCA $46.6; Medicare’s interquartile range is tight at $4. Overall, Cigna exhibits the widest interquartile spread at $66.3, suggesting greater variability in commercial contract rates, while Medicare is the tightest at $4, indicating highly consistent locality-based rates.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old male with newly diagnosed localized prostate cancer (C61) is referred to a radiation oncology clinic for definitive external beam radiation therapy. After consultation and diagnostic imaging, the radiation oncologist performs clinical treatment planning to determine beam entry points (ports), number of ports, beam energies, shielding block design, and mode of therapy (e.g., intensity-modulated external beam therapy or combination with brachytherapy). The workflow includes: review of diagnostic studies and prior treatments; physical exam and simulation session with immobilization devices; contouring of target volumes and organs at risk on planning CT; selection of beam arrangements and energies; design and placement of shielding blocks or multileaf collimator settings; and documentation of the chosen treatment technique and fractionation schedule. This planning visit results in a written and electronic plan used by the dosimetrist and medical physicist to generate the final treatment plan and to deliver image-guided radiation therapy at an outpatient radiation therapy center or hospital-based radiation oncology department.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    77262Clinical Treatment Planning (External and Internal Sources) for Radiation Treatment (intermediate complexity)Used for cases requiring a moderate level of decision making and planning complexity; alternative level depending on target complexity and documentation.

    Related Modifiers

    10 rows

    ModifierDescriptionWhen to Use
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    81Modifier -81 indicates a physician served as a minimal assistant surgeon for part—not all—of an operative procedure. Use when a physician’s assisting role is limited and does not represent full…- Use CPT modifier -81 when a physician acts as a minimum assistant surgeon who assists during only part (a limited portion) of an operative procedure; append -81 to the primary surgical CPT code to…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    2085R0001X
    2085N0700X
    2085B0100X
    2279C0205X
    207QP0002X
    251T00000X
    311500000X
    315D00000X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    C15.9Malignant neoplasm of esophagus, unspecified
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C22.0Liver cell carcinoma
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C43.9Malignant melanoma of skin, unspecified
    C50.911Malignant neoplasm of unspecified site of right female breast
    C50.912Malignant neoplasm of unspecified site of left female breast
    C56.9Malignant neoplasm of unspecified ovary

    Showing 1–10 of 28

    Related Payer Policy Updates

    Specialty: Pediatrics/Neonatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policybcbsvermont2026-12-01
    Inhaled Nitric Oxide Therapy (for New Mexico Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for North Carolina Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Clinical Policy: NICU Apnea Bradycardia GuidelinesAmbetter Nevada2026-10-01
    DRG Newborn Inpatient Stays - FacilityBlue Cross Blue Shield - Maine2026-10-01
    Pediatric Preventive ScreeningOscar Health2026-10-01
    Infant Nutritional FormulaCigna2026-09-15
    Pediatric Preventive ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    CPT-77262-RADIATION-THERAPY-TREATMENT-PLANNING-DETAILED

    CPT 77262: Radiation Therapy Treatment Planning and Management

    CPT-77263-RADIATION-THERAPY-TREATMENT-PLANNING

    CPT 77263: Complex Radiation Therapy Treatment Planning

    CPT-77280-RADIATION-THERAPY-SIMULATION-SIMPLE

    CPT 77280: Simple Radiation Therapy Simulation and Port Localization

    CPT-77285-RADIATION-THERAPY-SIMULATION-PORT-LOCALIZATION

    CPT 77285: Radiation Therapy Simulation for Port Localization

    CPT-77290-RADIATION-TREATMENT-SIMULATION-PLANNING

    CPT 77290: 3D Radiation Therapy Simulation and Treatment Field Localization

    CPT-77293-4D-CT-RESPIRATION-CORRELATED-SIMULATION-FOR-RADIATION-PLANNING

    CPT 77293: 4D (respiration‑correlated) CT Simulation for Radiotherapy

    CPT-77295-3D-DOSE-RECONSTRUCTION-VOLUMETRIC-DOSE-CALCULATION

    CPT 77295: 3D Dose Reconstruction and Volumetric Dose Calculation

    CPT-77299-THERAPEUTIC-RADIOLOGY-TREATMENT-PLANNING-UNLISTED

    CPT 77299: Therapeutic Radiology Clinical Treatment Planning

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    77263Clinical Treatment Planning (External and Internal Sources) for Radiation Treatment (complex planning)Used when planning involves highly complex target volumes, multiple modalities (e.g., combined external beam and brachytherapy), or extensive dosimetric calculations that exceed the complexity of 77261.