CPT code 77290: Radiation simulation, complex setup2026 Medicare rate & RVUs

Medicare pays $441.56 for 77290 nationally in the office. Local office rates run $385.31–$616.85.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 77290 covers

The radiation oncology team uses simulation to reproduce the treatment position and define the fields for a planned course of radiation therapy. The patient is positioned as they will be for treatment, and imaging and setup devices help the team identify and document the treatment geometry. This complex level is selected when the simulation and field arrangement require greater complexity than a simple or intermediate setup; the treating site and arrangement of fields support that distinction.

Report 77290 for the simulation service, not as a substitute for the separate work of evaluating treatment-planning complexity or developing a three-dimensional plan. The record should support the complexity of the setup, including the positioning, imaging, devices, and field arrangement used. CMS recognizes separately priced professional and technical components: bill modifier 26 for the professional interpretation, modifier TC for the equipment and staff portion, or no component modifier for 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 77290 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

77290 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 77290 rate is calculated

Each of 77290’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.

Payment rules and modifiers for 77290

The CMS indicators that decide how 77290 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

77290 compared with similar codes

How to choose

77280Radiation simulationSimple field setup

Use 77280 for a simple simulation setup; 77290 requires documentation supporting a complex setup and field arrangement.

77285Radiotherapy simulationIntermediate complexity

Use 77285 for intermediate simulation complexity. Choose 77290 when the documented simulation and field arrangement meet the complex level.

77295Radiotherapy planThree-dimensional plan

77290 covers simulation and treatment-field setup; 77295 describes development of a three-dimensional radiation treatment plan.

77263Treatment planningComplex planning

77263 represents complex treatment-planning evaluation, whereas 77290 reports the simulation used to establish the treatment setup and fields.

Codes related to 77290

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates