Summary & Overview
CPT 77280: Radiation Therapy Simulation, Simple
CPT code 77280 denotes a simple radiation therapy simulation service in which a provider uses a simulator or other imaging modality to determine the size and location of ports for radiation delivery. As the initial planning step for straightforward radiation treatments, this code standardizes billing for basic simulation procedures that establish beam geometry and patient positioning.
Key national payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines which payers recognize and reimburse CPT code 77280, common billing modifiers that may be applied, and the clinical context distinguishing simple from more complex simulation services.
Readers will find benchmarks and policy-relevant details, including typical sites of service (radiation oncology departments, hospital outpatient departments, and freestanding radiation therapy centers), the clinical intent of the service, and operational considerations for coding and claims submission. Where specific payer policies or rates are not provided in the input, the text notes that data are not available in the input. This national overview is intended to orient clinicians, billing professionals, and policy analysts to the role of CPT code 77280 in radiation therapy workflows and billing practices.
Billing Code Overview
CPT code 77280 describes a simple treatment simulation in radiation oncology during which a provider uses a simulator or other imaging modality to determine the size and location of ports to be used for radiation therapy. This service captures the planning simulation step that establishes beam geometry and patient positioning for a straightforward radiation treatment approach.
Service Type: Radiation therapy simulation (simple level)
Typical Site of Service: Radiation oncology department, hospital outpatient department, or freestanding radiation therapy center
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with a newly diagnosed left-sided breast carcinoma is referred to radiation oncology for adjuvant external beam radiotherapy following lumpectomy. The radiation oncologist schedules a simulation visit to localize treatment fields and determine the size and location of immobilization devices and beam ports. During the simulation, the patient is positioned supine on the CT simulation couch with a breast board and thermoplastic immobilization as needed. A CT simulation scan is obtained and the provider uses the simulator images to define field edges and mark skin reference points; simple port placement and field size determination are performed for a standard tangential breast technique. The clinical workflow includes patient check-in, positioning and immobilization, acquisition of simulation imaging, provider review and determination of port locations and field sizes, documentation of simulation parameters in the medical record, and communication to the dosimetry and physics teams for treatment planning. This service is a single, simple-level simulation visit that does not require complex immobilization, gating, or multiple simulation scans.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | When billing only the physician interpretation/planning portion if technical component billed separately |