CurrentPremera BluecrossPolicy CP.PP.427.v1.1

Intensity Modulated Radiation Therapy (IMRT)/Proton Beam Therapy Planning and Treatment Coding - Outpatient Facility claims

Defines how the Plan recognizes and reimburses services included in IMRT treatment plans when submitted on outpatient facility claims for Premera Blue Cross lines of business; affects facility billing and claims adjudication for IMRT/proton beam planning and related procedures.

Policy Summary

PayerPremera Bluecross

PolicyIMRT/Proton Beam Therapy Planning and Treatment Coding - Outpatient Facility claims

Policy CodePolicy CP.PP.427.v1.1

Change TypeCode inclusivity and coding clarifications

Effective DateOct 3, 2025

Next Review Date

Key ActionDo not report the listed procedure codes separately on the same facility claim when they are part of the IMRT plan (77301) if performed on the same date or within 30 days; use modifier 59/XS only for unrelated services with documentation.

SourceLink

POLICY UPDATE CHANGES

Effective with claim dates of service on and after October 3, 2025, a list of CPT procedure codes (including 77014, 77280, 77285, 77290, 77295, 77306, 77307, 77316, 77317, 77318, 77321, 77331, and 77370) are considered inclusive to CPT code 77301 when submitted within 30 days before/after or on same date as 77301.

Override modifiers are not allowed per NCCI edits if treating the same tumor; modifier 59 or XS may be appropriate when services are for a different tumor with supporting documentation.

Updated code 77014 to indicate termination effective January 1, 2026.

30-dayInclusive timeframe to 77301

13CPT codes listed

NCCI editsModifier rules

1/1/202677014 termination

Coverage and Billing Rules for IMRT Planning

IMRT planning coverage rules

Covered when ALL of the following are met:

CPT 77301 (Intensity modulated radiotherapy plan) includes related radiation therapy services performed as part of development of the IMRT plan; listed CPT codes are considered inclusive to 77301 when billed by the same facility on the same date or within 30 days before or after 77301.

Effective with claim dates of service on and after October 3, 2025, the following CPT procedure codes are considered inclusive to 77301 when submitted on the same date or within 30 days before/after 77301: 77014 (code terminated effective January 1, 2026), 77280, 77285, 77290, 77295, 77306, 77307, 77316, 77317, 77318, 77321, 77331, and 77370.

These listed procedure codes should NOT be reported separately by the same facility if they are performed as part of developing an IMRT treatment plan, whether billed on the same date of service as 77301 or within 30 days before or after 77301.

Override modifiers are not allowed per National Correct Coding Initiative (NCCI) edits when services are for the same tumor.

Policy Summary

PayerPremera Bluecross

PolicyIMRT/Proton Beam Therapy Planning and Treatment Coding - Outpatient Facility claims

Policy CodePolicy CP.PP.427.v1.1

Change TypeCode inclusivity and coding clarifications

Effective DateOct 3, 2025

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Relevant CPT Codes and Timeframes

IMRT-related CPT codes referencedCPTCovered

77301	Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
77014	Computed tomography guidance for placement of radiation therapy fields (code terminated effective January 1, 2026)
77280	Therapeutic radiology simulation-aided field setting; simple
77285	Therapeutic radiology simulation-aided field setting; intermediate
77290	Therapeutic radiology simulation-aided field setting; complex
77295	3-dimensional radiotherapy plan, including dose-volume histograms
77306	Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s)
77307	Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s)
77316	Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
77317	Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)

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Inclusion timeframe relative to 77301

Inclusion timeframeCodes listed are considered inclusive to CPT 77301 when billed by the same facility on the same date or within 30 days before or after 77301.

Applies to these CPT codes77014 (terminated effective 1/1/2026), 77280, 77285, 77290, 77295, 77306, 77307, 77316, 77317, 77318, 77321, 77331, 77370.

Same-facility reporting ruleThese procedure codes should not be reported separately by the same facility if performed as part of developing an IMRT treatment plan.

Exception — different tumorIf procedures represent services for a different tumor on a different date unrelated to the IMRT plan, modifier 59 or XS may be appropriate with supporting documentation and diagnoses.

Effective datePolicy effective for claim dates of service on and after October 3, 2025.

Billing Guidance and Provider Requirements

Billing Rule

Billing/Authorization Guidance for IMRT-related Codes

Do not report the listed procedure codes separately on the same facility claim when they are part of the IMRT treatment planning process. These codes should not be billed separately if performed as part of developing an IMRT treatment plan, whether billed on the same date of service as the IMRT treatment planning code (77301) or within 30 days before or after the date of the IMRT procedure code. Override modifiers are not allowed per National Correct Coding Initiative (NCCI) edits when treating the same tumor. If the procedures represent a service for a different tumor on a different date of service unrelated to the IMRT plan/service (77301), appending modifier 59 (Distinct Procedural Service) or modifier XS (Separate Structure) to the listed codes may be appropriate when supported by documentation and diagnosis.

Affected CPT codes include: 77014 (terminated effective 2026-01-01), 77280, 77285, 77290, 77295, 77306, 77307, 77316, 77317, 77318, 77321, 77331, 77370.
IMRT treatment planning CPT code: 77301.
Modifier guidance: do not use override modifiers for same-tumor services; use 59 or XS only when service is for a different, unrelated tumor and documentation supports it.

OpenPayer

Intensity Modulated Radiation Therapy (IMRT)/Proton Beam Therapy Planning and Treatment Coding - Outpatient Facility claims

Coverage and Billing Rules for IMRT Planning

Relevant CPT Codes and Timeframes

Billing Guidance and Provider Requirements

Definitions