CurrentUnitedHealthcarePolicy 2026R0130C

IMRT (Intensity Modulated Radiation Therapy) — Simulation, Planning and Related Services Reimbursement

Governs UnitedHealthcare reimbursement for services billed on the CMS-1500 (1500) form related to Intensity Modulated Radiation Therapy (IMRT) simulation, planning, and related radiation therapy services for Commercial and Individual Exchange members; applies to network and non‑network physicians and qualified health care professionals (excluding UnitedHealthcare Oxford).

Policy Summary

PayerUnitedHealthcare

PolicyIMRT (Intensity Modulated Radiation Therapy) — Simulation, Planning and Related Services Reimbursement

Policy CodePolicy 2026R0130C

Change TypeNo material changes

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionWhen IMRT simulation (77280-77290) and related services are performed by the same group within defined windows, consider them included in the IMRT plan unless reported with modifier 59 or XU to indicate separate, distinct services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

90 daysSimulation inclusion window

30 daysRelated services inclusion window

77301IMRT plan code

77280-77290Simulation codes

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Coverage and Reimbursement Criteria for IMRT

IMRT inclusion and separate reimbursement criteria

When services are considered included in the IMRT plan and when separate reimbursement is allowed:

IMRT plan (CPT 77301) includes simulation services (CPT 77280-77290) performed in development of the IMRT plan when reported by the Same Group Physician and/or Other Qualified Health Care Professional within 90 days prior to the IMRT plan date of service.

IMRT plan (CPT 77301) includes related radiation therapy services (CPT 77295, 77306, 77307, 77321, 77331, 77370) when those services are performed 30 days before, on, or after the IMRT plan date of service and are reported by the Same Group Physician and/or Other Qualified Health Care Professional.

Exception — separate/distinct services

To report simulation or related radiation therapy services that are for a different tumor (i.e., separate, distinct and unrelated to the IMRT plan), append an appropriate modifier (e.g., modifier 59 or XU) to indicate the service is separate and distinct.
Procedure-to-procedure edits for services reported on the same date remain applicable and should not be circumvented by reporting services on different dates; see UnitedHealthcare Rebundling or CCI Editing policies.

Subsequent simulations and boost plans

Subsequent IMRT simulation(s) performed after treatment has begun may be reimbursed; when the subsequent simulation is for a separate and distinct non‑IMRT radiation therapy for a different tumor, reimbursement may require modifier 59 or XU.
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.

For purposes of these inclusion windows, Same Group Physician and/or Other Qualified Health Care Professional is defined as all physicians and/or Other Qualified Health Care Professionals of the same group reporting the same Federal Tax Identification number.

CPT Codes, Modifiers and Inclusion Windows

IMRT plan and related planning codesCPT

77301	Intensity modulated radiotherapy plan
77295	External beam isodose planning
77306	External beam isodose planning
77307	External beam isodose planning
77321	Special teletherapy port plan
77331	Special dosimetry
77370	Medical physics consultation

Simulation codesCPT

77280-77290

Simulation codes

IMRT treatment delivery codesCPT

77402, 77407, 77412

IMRT treatment delivery codes

Inclusion windows — simulation within 90 days and related services within 30 days when by same group

Simulation inclusion windowSimulation services (CPT 77280-77290) performed within 90 days prior to the IMRT plan (CPT 77301) are considered included in the IMRT plan when billed by the Same Group Physician/Other Qualified Health Care Professional.

Related services inclusion windowRelated radiation therapy services (CPT 77295, 77306, 77307, 77321, 77331, 77370) reported 30 days before, on, or after the IMRT plan date are considered included when billed by the Same Group.

Date-of-service independence noteInclusion applies whether services are reported on the same or different dates of service, provided the Same Group condition and time windows are met.

Exception for different tumorTo report simulation or related services for a different tumor on a different date of service, report an appropriate modifier (e.g., 59 or XU) to indicate the service is separate, distinct and unrelated.

Provider Billing and Documentation Actions

Billing Rule

Billing rules: IMRT simulation and related services inclusion windows and modifiers

When IMRT simulation (CPT 77280-77290) is performed within 90 days prior to an IMRT plan (CPT 77301) by the Same Group Physician and/or Other Qualified Health Care Professional, UnitedHealthcare considers the simulation included in reimbursement for the IMRT plan. Related radiation therapy services (77295, 77306, 77307, 77321, 77331, 77370) performed 30 days before, on, or after the IMRT plan are also considered included when reported by the Same Group. Use modifier 59 or XU to report services that are separate, distinct, and unrelated (for example, treatment of a different tumor). UnitedHealthcare may reimburse subsequent simulations after treatment begins; subsequent simulations or additional plans (e.g., boost treatment) may require modifier 59 or XU to indicate they are separate and distinct.

Simulation reported within 90 days prior to CPT 77301 is considered included when billed by the Same Group Physician/Qualified Health Care Professional (chunk 7).
Related services reported 30 days before, on, or after CPT 77301 are considered included when billed by the Same Group (chunk 8).
Use modifier 59 or XU to indicate services that are separate, distinct, and unrelated; subsequent simulations or boost plans may require these modifiers (chunks 7 and 9).

Key Definitions

Same Group Physician/Other Qualified Health Care Professional — definition of same group (shared Federal Tax ID)

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

ApplicabilityUsed to determine when simulation and related radiation therapy services are considered included in the IMRT plan for reimbursement purposes.

Billing implicationServices billed by providers sharing the same Federal Tax ID are evaluated under the Same Group rule for the 90‑day (simulation) and 30‑day (related services) inclusion windows.

IMRT plan (CPT 77301) definition — includes related simulation and planning work performed prior to or as part of plan development

Code and definitionCPT 77301 — Intensity modulated radiotherapy plan; includes related simulation and planning work performed prior to or as part of plan development.