CurrentColorado Rocky Mountain Health PlansPolicy 2026R0130B

CMS-1500 Reimbursement for IMRT (simulation, planning, delivery)

This policy governs reimbursement rules for IMRT-related services billed on the CMS-1500 (or electronic equivalent) for UnitedHealthcare Commercial and Individual Exchange plans and applies to all physicians and other qualified health care professionals billing under the same federal tax ID.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyCMS-1500 Reimbursement for IMRT (simulation, planning, delivery)

Policy CodePolicy 2026R0130B

Change TypeRevised — Reimbursement Guidelines and Q&A updated

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionUse modifier 59 or XU to indicate simulation or related services that are separate and distinct from the IMRT plan when they are for a different tumor or otherwise unrelated.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Guidelines and Questions and Answers sections were updated.

90 dayssimulation inclusion window

30 daysrelated services window

CPT 77301IMRT plan code

59/XUseparate-service modifiers

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IMRT bundling and reimbursement criteria

Covered when the following bundling and reimbursement rules are met:

IMRT plan (CPT 77301) includes simulation services (CPT 77280-77290) performed in development of the plan when reported by the Same Group and the simulation date is within 90 days prior to the IMRT plan date.

Related radiation therapy services (CPT 77295, 77306, 77307, 77321, 77331, 77370) performed in development of the IMRT plan are considered included in CPT 77301 when reported by the Same Group if performed within 30 days before, on, or after the IMRT plan date.

Image-guided radiation therapy (CPT 77387) will not be separately reimbursed when billed on the same date of service as IMRT plan (CPT 77301).

To report simulation or related services for a different tumor or to indicate services are separate and distinct from the IMRT plan, append an appropriate modifier (e.g., 59 or XU).

Subsequent or additional services

Subsequent IMRT simulation(s) after treatment has begun may be reimbursed to accommodate changes in the tumor; these may require modifier 59 or XU to indicate they are separate and distinct non-IMRT radiation therapy for a different tumor.
An additional IMRT treatment plan for a Boost Treatment may be reimbursed when reported with modifier 59 or XU to indicate it is separate and distinct from the original IMRT plan.

Same Group is defined as all physicians and other qualified health care professionals reporting the same Federal Tax Identification number.

Procedure Codes, Inclusion Windows, and Coding Guidance

IMRT-related procedure codesCPT

77301	IMRT treatment planning (plan includes related pre-plan services)
77280-77290	Radiation therapy simulation codes (considered included in 77301 when performed for same tumor within 90 days)
77295	External beam isodose planning (included with 77301 when related)
77306	Dosimetry (included with 77301 when related)
77307	Isodose planning (included with 77301 when related)
77321	Special teletherapy port plan (included with 77301 when related)
77331	Special dosimetry (included with 77301 when related)
77370	Medical physics consultation (included with 77301 when related)
77387	Image-guided radiation therapy (not separately reimbursed when billed same date as 77301)

Inclusion windows

Inclusion window for simulationSimulation services (CPT 77280-77290) performed for the same tumor within 90 days prior to the IMRT plan (CPT 77301) are considered included in 77301 when reported by the Same Group.

Inclusion window for related servicesRelated radiation therapy services (CPT 77295, 77306, 77307, 77321, 77331, 77370) performed 30 days before, on, or after the IMRT plan date are considered included in 77301 when reported by the Same Group.

Image‑guided therapy billing noteImage-guided radiation therapy (CPT 77387) will not be separately reimbursed when billed on the same date as IMRT plan (CPT 77301); see UnitedHealthcare's CCI Editing policy.

Billing and Reporting Actions for IMRT Simulation and Related Services

Billing Rule

Billing and Documentation Requirements for IMRT Simulation and Related Services

Providers must follow billing and documentation rules when reporting IMRT simulation and related services. CPT code 77301 (IMRT treatment planning) includes the work of related simulation and planning services when performed for the same tumor; report separate, distinct services for different tumors or clinical episodes using the appropriate modifier and supporting documentation. Failure to use modifiers or adequate documentation may result in claim denials or bundling under CCI/rebundling edits.

IMRT plan (77301) includes simulation services (CPT 77280-77290) and related planning services (77295, 77306, 77307, 77321, 77331, 77370) when performed for the same tumor.
When reporting simulation or related services for a different tumor or unrelated clinical episode, append and submit the appropriate modifier (e.g., 59, XU) and contemporaneous documentation to demonstrate the service is separate and distinct.
For UnitedHealthcare purposes: simulation services reported within 90 days prior to the IMRT plan date are considered included when billed by the same group (77301 and 77280-77290) — verify payer-specific timeframe and group rules.
Image-guided RT (77387) will not be separately reimbursed when billed on the same date of service as 77301; follow CCI edits.
Do not circumvent procedure-to-procedure edits by shifting services to different dates of service; claims may be subject to rebundling/CCI edits.
Subsequent IMRT simulations performed after treatment initiation may be reimbursed when medically necessary; when they represent a separate, distinct non-IMRT radiation therapy (different tumor or boost), report with modifier 59 or XU and supporting documentation.

Key Definitions

Same Group

Same Group definitionAll physicians and/or Other Qualified Health Care Professionals of the same group reporting the same Federal Tax Identification number.

ApplicabilityApplies to reporting of simulation, planning, and related radiation therapy services under this IMRT policy for UnitedHealthcare Commercial and Individual Exchange plans.

Use with modifiersWhen services are for a different tumor or are separate and distinct, append an appropriate modifier (e.g., 59 or XU) to indicate unrelated services.

IMRT (definition)

DefinitionIntensity Modulated Radiation Therapy (IMRT) is an advanced form of conformal external beam radiation therapy that uses computer-controlled linear accelerators to deliver precise radiation doses while minimizing dose to surrounding normal critical structures.

ComponentsIMRT includes treatment planning (CPT 77301) with dose-volume histograms for target and critical structure partial tolerance specifications.

Service stagesIMRT care is described in stages: simulation (77280-77290), treatment planning (77301), and treatment delivery (77402, 77407, 77412).

Boost Treatment

Boost Treatment definitionOne or more extra treatments targeted at the tumor bed; uses a different treatment field and usually requires separate planning and set‑up before boost radiation is started.

Timing relative to regular sessionsBoost treatments are given after the regular sessions of radiation are complete.

Separate planning requirementBecause a different treatment field is used, a separate planning and set‑up session is usually required before the boost treatment.