CPT code 77261: Radiation planning, simple complexity2026 Medicare rate & RVUs in New York
Reports the radiation oncologist’s professional planning work for a simple radiation treatment approach after review of the patient’s clinical and tumor information.
Medicare pays $67.86–$79.26 for 77261 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 77261 covers
A radiation oncologist uses this service to develop a simple external-beam radiation treatment approach after reviewing relevant clinical information, such as the cancer diagnosis, disease extent, imaging, and prior treatment. Planning may include defining the treatment approach and determining the intended dose and beam arrangement. It is performed in radiation oncology practices and hospital-based cancer centers as part of preparing a patient’s course of treatment.
Select the simple level based on the documented complexity of the physician’s planning work; do not infer the level from a field count alone. The record should support the clinical information reviewed and the treatment decisions made. CMS identifies 77261 as a professional-component-only service: it represents the physician’s interpretation and report, while a separate code accounts for the technical portion. Field simulation and dosimetry calculations are distinct services when performed and documented; this planning code does not itself describe those services.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 77261 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$67.86 to $79.26
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $77.95 | $77.95 |
| NYC suburbs and Long Island, NY | $79.26 | $79.26 |
| Poughkeepsie and northern NYC suburbs, NY | $74.59 | $74.59 |
| Queens, NY | $78.12 | $78.12 |
| Rest of New York | $67.86 | $67.86 |
How the 77261 rate is calculated
Each of 77261’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 77261
RVUs × geographic indexes × conversion factor
Work1.27
1.27 RVUs× 1.000 GPCI
Practice expense0.75
0.75 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
2.0900
Conversion factor
$33.4009
Medicare rate
$69.81
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77261
The CMS indicators that decide how 77261 is paid alongside other services.
CMS payment indicators · 77261
Radiation planning, simple complexity
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 2 | Professional component only. |
77261 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 77262Radiation planningIntermediate complexity
- Use 77262 when the documented physician planning work is intermediate in complexity rather than simple. The distinction rests on the complexity of the planning service, not field count alone.
- 77263Treatment planningComplex planning
- Use 77263 for complex treatment planning. 77261 represents the simple level and should not be selected when the record supports complex planning.
- 77280Radiation simulationSimple field setup
- 77280 reports simple radiation field simulation, which establishes treatment setup geometry. 77261 reports the physician’s treatment-planning work, not the simulation procedure.
- 77295Radiotherapy planThree-dimensional plan
- 77295 is for a three-dimensional radiotherapy plan. 77261 represents simple clinical treatment planning rather than a 3D plan.
77261 billing questions
How does 77261 differ from 77262?
77261 is for simple treatment planning, while 77262 is for intermediate planning. Choose the level supported by the physician’s documented planning complexity rather than relying on a field count alone.
Is treatment simulation included in 77261?
No. Simulation, such as setting up treatment geometry, is a distinct service. Code 77280 describes simple radiation field simulation when that service is performed and documented.
Does 77261 include the technical portion of planning?
No. CMS identifies 77261 as professional-component-only for the physician’s interpretation and report; a separate code covers the technical portion.
What documentation supports the simple planning level?
Document the clinical information reviewed and the physician’s treatment-planning decisions. The record should support why the planning work meets the simple level.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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