CPT code 77285: Radiotherapy simulation, intermediate complexity2026 Medicare rate & RVUs in Texas
Reports intermediate-complexity simulation for radiation treatment, where imaging and setup establish the patient's position and treatment-field arrangement.
Medicare pays $415.26–$476.93 for 77285 in the office in Texas, from Beaumont, TX to Austin, TX. 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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On this page 9 sections
What 77285 covers
Radiotherapy simulation establishes a reproducible treatment position and helps determine the arrangement of radiation fields before treatment begins. A radiation oncologist directs the clinical work, with radiation therapists typically operating the simulation equipment and assisting with patient setup. The service is performed in a radiation oncology department or other setting equipped for treatment simulation; it is not the delivery of therapeutic radiation.
Select 77285 when the documented simulation meets intermediate rather than simple or complex criteria. The record should support the simulation work performed, including patient positioning and the imaging or field-definition work that establishes the treatment setup. CMS recognizes separate professional and technical components: modifier 26 identifies the professional interpretation, modifier TC identifies the equipment and staff, and reporting without either modifier represents the global service.
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 77285 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$415.26 to $476.93
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $476.93 | Unavailable |
| Beaumont, TX | $415.26 | Unavailable |
| Brazoria, TX | $449.00 | Unavailable |
| Dallas, TX | $451.27 | Unavailable |
| Fort Worth, TX | $447.13 | Unavailable |
| Galveston, TX | $449.93 | Unavailable |
| Houston, TX | $451.02 | Unavailable |
| Rest of Texas | $431.46 | Unavailable |
How the 77285 rate is calculated
Each of 77285’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 · 77285
RVUs × geographic indexes × conversion factor
Work1.02
1.02 RVUs× 1.000 GPCI
Practice expense12.48
12.48 RVUs× 1.000 GPCI
Malpractice0.06
0.06 RVUs× 1.000 GPCI
Adjusted RVUs
13.5600
Conversion factor
$33.4009
Medicare rate
$452.92
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77285
The CMS indicators that decide how 77285 is paid alongside other services.
CMS payment indicators · 77285
Radiotherapy simulation, intermediate 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 | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
77285 without 26 · national office
$452.92
Radiotherapy simulation, intermediate complexity
77285-26 · Professional component
$55.78
Pays only the interpretation and report.
77285 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 77280Radiation simulationSimple field setup
- Use 77280 when the simulation meets simple-complexity criteria; 77285 represents the intermediate level.
- 77290Radiation simulationComplex setup
- Use 77290 when the simulation meets complex criteria. The distinction is the complexity of the simulation, not simply the number of fields.
- 77262Radiation planningIntermediate complexity
- 77262 represents intermediate therapeutic radiology treatment planning. 77285 represents simulation work that establishes the treatment setup and field arrangement.
77285 billing questions
How do I distinguish 77285 from 77280 or 77290?
Choose among these simulation levels according to the documented complexity of the work and the applicable CPT criteria. Do not assign the intermediate level based only on the number of treatment fields.
What does modifier 26 represent for 77285?
Modifier 26 reports the professional component, meaning the physician's interpretation. The unmodified code represents the global service when one entity reports both components.
When is modifier TC appropriate?
Use TC for the technical component, which covers the simulation equipment and staff. A claim without 26 or TC represents the global service.
Can 77285 be reported with treatment planning?
Simulation establishes positioning and field arrangement, while treatment planning represents separate planning work. Report each service when it was performed and the documentation supports it.
What documentation supports the intermediate level?
Document the simulation and patient setup, the imaging or field-definition work performed, and the details that establish intermediate rather than simple or complex work.
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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