CurrentUnitedHealthcarePolicy 2026R5038A

Therapeutic radiology clinical treatment planning — reimbursable units and Episode of Care rules

Defines reimbursable units and Episode of Care rules for therapeutic radiology clinical treatment planning (CPT 77261, 77262, 77263) for UnitedHealthcare Commercial and Individual Exchange plans; applies to services billed on CMS 1500 and UB04 forms and all providers.

Policy Summary

PayerUnitedHealthcare

PolicyTherapeutic radiology clinical treatment planning — reimbursable units and Episode of Care rules

Policy CodePolicy 2026R5038A

Change TypeAdded Q&A (brachytherapy exception)anniversary review

Effective Date

Next Review Date

Key ActionLimit reimbursable units to the per-episode caps within a 90-day Episode of Care; bill a new planning code to start a new Episode.

SourceLink

POLICY UPDATE CHANGES

Questions and Answers: Added question #4 (brachytherapy exception).

Anniversary review and version change on 2/1/2026.

90 daysEpisode of Care duration

77261–77263Primary CPT codes

Capped per episodeUnit limits

2026R5038AIdentifier

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.

Reimbursable units and Episode of Care criteria

UnitedHealthcare will reimburse specified units of treatment management codes within a 90‑day Episode of Care initiated by a planning code (77261, 77262, 77263).

An Episode of Care begins when the first therapeutic radiology clinical treatment planning code (77261, 77262, or 77263) is billed and extends up to 90 days or until a new planning code is billed.

Within the 90‑day Episode of Care, UnitedHealthcare will consider reimbursement only for the reimbursable units per treatment planning episode for the treatment management codes listed; units billed in excess of the reimbursable units per episode will not be considered for reimbursement.

Reimbursable units are defined per treatment management code as listed in the Applicable Codes section (examples include: 77280 = 4 units; 77285 = 2, 10, or 1 units depending on crosswalked CPT; 77290 = 3, 10, or 1 units; 77295 = 2 or 10 units; 77300 = 10 or 5 units).

Professional (26) and Technical (TC) components billed with the same code are aggregated when calculating accumulated units; other modifiers do not alter accumulation.

Exception: If brachytherapy services are billed within the same 90‑day Episode of Care, the unit limitations described in this policy do not apply.

Coding and Reimbursable Codes

Primary treatment planning codesCPTCovered

77261	Therapeutic radiology clinical treatment planning, complex
77262	Therapeutic radiology clinical treatment planning, intermediate
77263	Therapeutic radiology clinical treatment planning, simple

Treatment management codes with per-episode reimbursable unitsCPTCovered

77280	Treatment Management Code — Reimbursable Units Per Treatment Planning Episode = 4; CPT crosswalks include 77301, 77427 (other mappings with units 5 and 9 also listed)
77285	Treatment Management Code — Reimbursable Units Per Treatment Planning Episode = 2; CPT crosswalks include 77332, 77431 (other mapping with units up to 10 also listed)
77290	Treatment Management Code — Reimbursable Units Per Treatment Planning Episode = 3; CPT crosswalks include 77333, 77435 (other mappings with units up to 10 also listed)
77295	Treatment Management Code — Reimbursable Units Per Treatment Planning Episode = 2; CPT crosswalks include 77334 (other mappings with units up to 10 also listed)
77300	Treatment Management Code — Reimbursable Units Per Treatment Planning Episode = 10; CPT crosswalk includes 77338 (additional entry shows 5 units also listed)

Reimbursable units per Treatment Planning Episode

77280Reimbursable units per Treatment Planning Episode = 4 (policy lists multiple CPT crosswalk mappings to 77301, 77427 with varying unit values)

77285Reimbursable units per Treatment Planning Episode = 2 (mapped examples include CPT 77332, 77431 with listed unit values up to 10)

77290Reimbursable units per Treatment Planning Episode = 3 (policy shows mappings to CPT 77333, 77435 with additional listed units up to 10)

77295Reimbursable units per Treatment Planning Episode = 2 (mapped to CPT 77334 with additional example unit values up to 10)

77300Reimbursable units per Treatment Planning Episode = 10 (policy lists CPT 77338 and additional mappings with mixed unit values)

Provider Actions and Billing Rules

Denial Risk

Episode of Care unit limits and start rules

An Episode of Care begins when the first therapeutic radiology treatment planning CPT code (77261, 77262, or 77263) is billed and continues for up to 90 days or until a new planning code is billed. Within the Episode of Care, UnitedHealthcare will consider reimbursement for services and units outlined under the Treatment Management Codes. The reimbursable units per Episode of Care are intended to capture all reimbursable work associated with these planning codes. Units billed in excess of the reimbursable units per Episode of Care will not be considered for reimbursement. Additional reimbursement policies (for example IMRT, CCI, and Maximum Frequency Per Day) may also apply.

Episode length: 90 days from the first billed planning code (77261, 77262, 77263) or until a new planning code is billed.
Only one planning code is allowed per Episode of Care unless clinical condition changes justify a new planning code.
Units are accumulated across the Episode of Care; billed units above the reimbursable limit will be denied.

Billing Rule

Modifier impact on unit accumulation

When calculating allowed units within an Episode of Care, professional (modifier 26) and technical (modifier TC) components billed with the same CPT code will be combined and considered together for unit accumulation. Other modifiers may be appended but do not change how units accumulate toward the Episode limit.

Combine units for the same CPT code regardless of 26 or TC modifier when totaling Episode units.
Appending other modifiers does not alter unit accumulation or allowed counts.

Note

Brachytherapy exception

If brachytherapy services are billed within the same 90-day Episode of Care, the unit limitations described in this policy do not apply. When brachytherapy is present, providers should bill as appropriate for those services and note that Episode unit caps from this policy are waived for that Episode.

Presence of brachytherapy within the 90-day Episode waives the Episode unit limitations described in this policy.
Ensure accurate coding to reflect brachytherapy services so the exception is applied correctly.

Revision History

2026-02-01anniversary_review_and_version_changeLatest

Anniversary review and version change recorded for the policy.

2025-08-15policy_version_change

Policy version changed (history entry recorded).

2025-02-01qa_addition

Questions and Answers: Added question #4 specifying that when brachytherapy services are present within the 90-day Episode of Care, the unit limitations do not apply.

2025-01-22policy_implementation

Policy implemented by UnitedHealthcare Employer & Individual.