CPT code 77338: MLC design, per IMRT plan2026 Medicare rate & RVUs in North Dakota
Reports design of multileaf collimator devices that shape radiation fields for intensity-modulated radiation therapy, counted per IMRT plan.
In North Dakota, Medicare pays $470.00 for 77338 in the office.
Check a contract rate as a % of Medicare · 77338 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 77338 covers
This service covers planning the multileaf collimator (MLC) leaf positions needed to shape and modulate radiation fields for an intensity-modulated radiation therapy (IMRT) plan. A medical physicist or dosimetrist typically performs the technical design work as part of radiation treatment planning, with the radiation oncologist directing the treatment approach. The work supports delivery of the planned dose to the target while shaping radiation around nearby normal tissues.
Report the service per IMRT plan, not per treatment fraction. Documentation should connect the MLC design to the specific IMRT plan and identify the design work performed. CMS recognizes professional and technical components: modifier 26 identifies the professional component, modifier TC identifies the technical component, and an unmodified claim represents the global service. The IMRT dose plan itself is reported separately when supported; MLC device design is distinct from dose calculation and from design of other treatment aids.
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.
How North Dakota compares for 77338
Across 109 of 109 payment localities, the office rate for 77338 runs from $424.80 in Arkansas to $630.98 in San Benito County, CA. North Dakota pays $470.00. The RVUs are the same everywhere; the geographic indexes change the dollars.
- North Dakota · this page$470.00
- Los Angeles, CA · California$537.72+$67.72
- Washington, DC area · District of Columbia$541.65+$71.65
- Miami, FL · Florida$501.14+$31.14
- Chicago, IL · Illinois$488.39+$18.39
- Manhattan, NY · New York$541.76+$71.76
- Alaska · Alaska$562.27+$92.27
Other areas in North Dakota first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $430.46 | — |
| ArkansasArkansas | $424.80 | — |
| ArizonaArizona | $463.62 | — |
| Bakersfield, CACalifornia | $505.74 | — |
| Chico, CACalifornia | $504.85 | — |
| El Centro, CACalifornia | $504.89 | — |
| Fresno, CACalifornia | $504.85 | — |
| Hanford, CACalifornia | $504.85 | — |
| Madera, CACalifornia | $504.85 | — |
| Merced, CACalifornia | $504.85 | — |
| Modesto, CACalifornia | $504.85 | — |
| Napa, CACalifornia | $583.63 | — |
| Oxnard, CACalifornia | $535.24 | — |
| Redding, CACalifornia | $504.85 | — |
| Rest of CaliforniaCalifornia | $504.85 | — |
| Riverside, CACalifornia | $507.64 | — |
| Sacramento, CACalifornia | $529.41 | — |
| Salinas, CACalifornia | $527.41 | — |
| San Diego, CACalifornia | $539.42 | — |
| Marin County, CACalifornia | $617.77 | — |
| San Francisco, CACalifornia | $617.49 | — |
| San Benito County, CACalifornia | $630.98 | — |
| Santa Clara County, CACalifornia | $629.82 | — |
| San Luis Obispo, CACalifornia | $518.91 | — |
| Santa Cruz, CACalifornia | $544.32 | — |
| Santa Maria, CACalifornia | $529.28 | — |
| Santa Rosa, CACalifornia | $549.83 | — |
| Stockton, CACalifornia | $504.85 | — |
| Vallejo, CACalifornia | $583.22 | — |
| Visalia, CACalifornia | $504.85 | — |
| Yuba City, CACalifornia | $504.85 | — |
| ColoradoColorado | $495.74 | — |
| ConnecticutConnecticut | $504.69 | — |
| DelawareDelaware | $470.89 | — |
| Fort Lauderdale, FLFlorida | $485.96 | — |
| Rest of FloridaFlorida | $464.77 | — |
| Atlanta, GAGeorgia | $482.29 | — |
| Rest of GeorgiaGeorgia | $441.25 | — |
| Hawaii, Guam, HIHawaii | $516.24 | — |
| IowaIowa | $442.13 | — |
| IdahoIdaho | $444.40 | — |
| East St. Louis, ILIllinois | $457.27 | — |
| Rest of IllinoisIllinois | $451.21 | — |
| Suburban Chicago, ILIllinois | $491.21 | — |
| IndianaIndiana | $446.80 | — |
| KansasKansas | $439.43 | — |
| KentuckyKentucky | $437.95 | — |
| New Orleans, LALouisiana | $456.80 | — |
| Rest of LouisianaLouisiana | $437.01 | — |
| Metropolitan Boston, MAMassachusetts | $543.20 | — |
| Rest of MassachusettsMassachusetts | $492.83 | — |
| Baltimore area, MDMaryland | $503.04 | — |
| Rest of MarylandMaryland | $479.60 | — |
| Rest of MaineMaine | $445.64 | — |
| Southern Maine, MEMaine | $468.94 | — |
| Detroit, MIMichigan | $469.24 | — |
| Rest of MichiganMichigan | $447.59 | — |
| MinnesotaMinnesota | $478.57 | — |
| Metropolitan Kansas City, MOMissouri | $454.82 | — |
| Metropolitan St. Louis, MOMissouri | $459.28 | — |
| Rest of MissouriMissouri | $429.62 | — |
| MississippiMississippi | $427.33 | — |
| MontanaMontana | $474.94 | — |
| North CarolinaNorth Carolina | $450.04 | — |
| NebraskaNebraska | $444.59 | — |
| New HampshireNew Hampshire | $487.32 | — |
| Northern New JerseyNew Jersey | $536.64 | — |
| Rest of New JerseyNew Jersey | $511.44 | — |
| New MexicoNew Mexico | $449.50 | — |
| NevadaNevada | $473.89 | — |
| NYC suburbs and Long Island, NYNew York | $552.85 | — |
| Poughkeepsie and northern NYC suburbs, NYNew York | $514.06 | — |
| Queens, NYNew York | $547.10 | — |
| Rest of New YorkNew York | $456.13 | — |
| OhioOhio | $446.58 | — |
| OklahomaOklahoma | $438.11 | — |
| Portland, OROregon | $511.35 | — |
| Rest of OregonOregon | $471.17 | — |
| Metropolitan Philadelphia, PAPennsylvania | $492.49 | — |
| Rest of PennsylvaniaPennsylvania | $447.69 | — |
| Puerto RicoPuerto Rico | $478.43 | — |
| Rhode IslandRhode Island | $487.50 | — |
| South CarolinaSouth Carolina | $448.86 | — |
| South DakotaSouth Dakota | $469.42 | — |
| TennesseeTennessee | $441.34 | — |
| Austin, TXTexas | $493.25 | — |
| Beaumont, TXTexas | $444.94 | — |
| Brazoria, TXTexas | $471.30 | — |
| Dallas, TXTexas | $473.72 | — |
| Fort Worth, TXTexas | $470.56 | — |
| Galveston, TXTexas | $472.35 | — |
| Houston, TXTexas | $476.93 | — |
| Rest of TexasTexas | $457.47 | — |
| UtahUtah | $454.49 | — |
| VirginiaVirginia | $466.95 | — |
| Virgin Islands, VIUnited States Virgin Islands | $478.43 | — |
| VermontVermont | $467.57 | — |
| Rest of WashingtonWashington | $492.11 | — |
| King County, WAWashington | $554.64 | — |
| WisconsinWisconsin | $455.45 | — |
| West VirginiaWest Virginia | $435.72 | — |
| WyomingWyoming | $472.79 | — |
77338 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$424.80
$567.92
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $562.27 | 1 |
| AL | $430.46 | 1 |
| AR | $424.80 | 1 |
| AZ | $463.62 | 1 |
| CA | $504.85–$630.98 | 29 |
| CO | $495.74 | 1 |
| CT | $504.69 | 1 |
| DC | $541.65 | 1 |
| DE | $470.89 | 1 |
| FL | $464.77–$501.14 | 3 |
| GA | $441.25–$482.29 | 2 |
| GU | $516.24 | 1 |
| HI | $516.24 | 1 |
| IA | $442.13 | 1 |
| ID | $444.40 | 1 |
| IL | $451.21–$491.21 | 4 |
| IN | $446.80 | 1 |
| KS | $439.43 | 1 |
| KY | $437.95 | 1 |
| LA | $437.01–$456.80 | 2 |
| MA | $492.83–$543.20 | 2 |
| MD | $479.60–$541.65 | 3 |
| ME | $445.64–$468.94 | 2 |
| MI | $447.59–$469.24 | 2 |
| MN | $478.57 | 1 |
| MO | $429.62–$459.28 | 3 |
| MS | $427.33 | 1 |
| MT | $474.94 | 1 |
| NC | $450.04 | 1 |
| ND | $470.00 | 1 |
| NE | $444.59 | 1 |
| NH | $487.32 | 1 |
| NJ | $511.44–$536.64 | 2 |
| NM | $449.50 | 1 |
| NV | $473.89 | 1 |
| NY | $456.13–$552.85 | 5 |
| OH | $446.58 | 1 |
| OK | $438.11 | 1 |
| OR | $471.17–$511.35 | 2 |
| PA | $447.69–$492.49 | 2 |
| PR | $478.43 | 1 |
| RI | $487.50 | 1 |
| SC | $448.86 | 1 |
| SD | $469.42 | 1 |
| TN | $441.34 | 1 |
| TX | $444.94–$493.25 | 8 |
| UT | $454.49 | 1 |
| VA | $466.95–$541.65 | 2 |
| VI | $478.43 | 1 |
| VT | $467.57 | 1 |
| WA | $492.11–$554.64 | 2 |
| WI | $455.45 | 1 |
| WV | $435.72 | 1 |
| WY | $472.79 | 1 |
How the 77338 rate is calculated
Each of 77338’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 · 77338
RVUs × geographic indexes × conversion factor
Work4.18
4.18 RVUs× 1.000 GPCI
Practice expense9.79
9.79 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
14.2200
Conversion factor
$33.4009
Medicare rate
$474.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact North Dakota inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
9,084
- Code
- 77338
- Physician work
- 4.18
- Practice expense
- 9.79
- Malpractice
- 0.25
GPCI2026.csv
84
- Locality
- North Dakota
- Physician work
- 1.000
- Practice expense
- 1.000
- Malpractice
- 0.406
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 4.18 | × 1.000 | 4.1800 |
| Practice expense | 9.79 | × 1.000 | 9.7900 |
| Malpractice | 0.25 | × 0.406 | 0.1015 |
| Total RVUs | 14.0715 | ||
| Conversion factor | × 33.4009 | ||
Office rate, North Dakota$470.00
Office: (4.18 × 1 + 9.79 × 1 + 0.25 × 0.406) × $33.4009 = $470.00
Payment rules and modifiers for 77338
The CMS indicators that decide how 77338 is paid alongside other services.
CMS payment indicators · 77338
MLC design, per IMRT plan
| 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
77338 without 26 · national office
$474.96
MLC design, per IMRT plan
77338-26 · Professional component
$225.12
Pays only the interpretation and report.
How 77338 has changed in North Dakota
77338 · Office / nonfacility
$470.00
Effective 2026-10-01
The base rate is $12.32 higher than on 2025-10-01, moving from $457.68 to $470.00 (2.7%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$457.68changed to$470.00
- Conversion factor 32.3465 changed to 33.4009
- Work RVU 4.29 changed to 4.18
- Practice expense RVU 9.73 changed to 9.79
- Malpractice GPCI 0.517 changed to 0.406
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$463.68changed to$457.68
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 9.50 changed to 9.73
- Malpractice RVU 0.27 changed to 0.25
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$456.11changed to$463.68
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$465.04changed to$456.11
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 9.31 changed to 9.50
- Malpractice RVU 0.26 changed to 0.27
- Malpractice GPCI 0.474 changed to 0.517
January 1, 2023
RVU23A
$461.03changed to$465.04
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 8.92 changed to 9.31
- Malpractice GPCI 0.431 changed to 0.474
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$476.31changed to$461.03
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 9.27 changed to 8.92
- Malpractice RVU 0.21 changed to 0.26
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$493.04changed to$476.31
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 9.26 changed to 9.27
- Malpractice RVU 0.23 changed to 0.21
- Malpractice GPCI 0.485 changed to 0.431
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$506.33changed to$493.04
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 9.63 changed to 9.26
- Malpractice RVU 0.24 changed to 0.23
- Malpractice GPCI 0.540 changed to 0.485
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$523.42changed to$506.33
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 10.12 changed to 9.63
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$512.90changed to$523.42
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 9.87 changed to 10.12
- Malpractice GPCI 0.547 changed to 0.540
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
$509.60changed to$512.90
- Conversion factor 35.8043 changed to 35.8887
- Practice expense RVU 9.81 changed to 9.87
- Malpractice GPCI 0.554 changed to 0.547
Held through RVU17B, RVU17C, RVU17D.
January 1, 2016
RVU16A
$504.29changed to$509.60
- Conversion factor 35.9335 changed to 35.8043
- Practice expense RVU 9.60 changed to 9.81
- Malpractice RVU 0.26 changed to 0.24
Held through RVU16B, RVU16C, RVU16D.
July 1, 2015
RVU15C
$501.78changed to$504.29
- Conversion factor 35.7547 changed to 35.9335
Held through RVU15D.
January 1, 2015
RVU15A
$497.56changed to$501.78
- Conversion factor 35.8228 changed to 35.7547
- Practice expense RVU 9.46 changed to 9.60
- Malpractice GPCI 0.536 changed to 0.554
Held through RVU15B.
January 1, 2014
RVU14A
$496.72changed to$497.56
- Conversion factor 34.0230 changed to 35.8228
- Practice expense RVU 10.17 changed to 9.46
- Malpractice RVU 0.27 changed to 0.26
- Malpractice GPCI 0.517 changed to 0.536
Held through RVU14B, RVU14C, RVU14D.
January 1, 2013
RVU13AR
Earliest loaded release: $496.72
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $470.00 | Not available in this setting | RVU26D |
| 2026-07-01 | $470.00 | Not available in this setting | RVU26C |
| 2026-04-01 | $470.00 | Not available in this setting | RVU26B |
| 2026-01-01 | $470.00 | Not available in this setting | RVU26A |
| 2025-10-01 | $457.68 | Not available in this setting | RVU25D |
| 2025-07-01 | $457.68 | Not available in this setting | RVU25C |
| 2025-04-01 | $457.68 | Not available in this setting | RVU25B |
| 2025-01-01 | $457.68 | Not available in this setting | RVU25A |
| 2024-10-01 | $463.68 | Not available in this setting | RVU24D |
| 2024-07-01 | $463.68 | Not available in this setting | RVU24C |
| 2024-04-01 | $463.68 | Not available in this setting | RVU24B |
| 2024-03-09 | $463.68 | Not available in this setting | RVU24AR |
| 2024-01-01 | $456.11 | Not available in this setting | RVU24A |
| 2023-10-01 | $465.04 | Not available in this setting | RVU23D |
| 2023-07-01 | $465.04 | Not available in this setting | RVU23C |
| 2023-04-01 | $465.04 | Not available in this setting | RVU23B |
| 2023-01-01 | $465.04 | Not available in this setting | RVU23A |
| 2022-10-01 | $461.03 | Not available in this setting | RVU22D |
| 2022-07-01 | $461.03 | Not available in this setting | RVU22C |
| 2022-04-01 | $461.03 | Not available in this setting | RVU22B |
| 2022-01-01 | $461.03 | Not available in this setting | RVU22A |
| 2021-10-01 | $476.31 | Not available in this setting | RVU21D |
| 2021-07-01 | $476.31 | Not available in this setting | RVU21C |
| 2021-04-01 | $476.31 | Not available in this setting | RVU21B |
| 2021-01-01 | $476.31 | Not available in this setting | RVU21A |
| 2020-10-01 | $493.04 | Not available in this setting | RVU20D |
| 2020-07-01 | $493.04 | Not available in this setting | RVU20C |
| 2020-04-01 | $493.04 | Not available in this setting | RVU20B |
| 2020-01-01 | $493.04 | Not available in this setting | RVU20A |
| 2019-10-01 | $506.33 | Not available in this setting | RVU19D |
| 2019-07-01 | $506.33 | Not available in this setting | RVU19C |
| 2019-04-01 | $506.33 | Not available in this setting | RVU19B |
| 2019-01-01 | $506.33 | Not available in this setting | RVU19A |
| 2018-10-01 | $523.42 | Not available in this setting | RVU18D |
| 2018-07-01 | $523.42 | Not available in this setting | RVU18C |
| 2018-04-01 | $523.42 | Not available in this setting | RVU18B |
| 2018-01-01 | $523.42 | Not available in this setting | RVU18AR1 |
| 2017-10-01 | $512.90 | Not available in this setting | RVU17D |
| 2017-07-01 | $512.90 | Not available in this setting | RVU17C |
| 2017-04-01 | $512.90 | Not available in this setting | RVU17B |
| 2017-01-01 | $512.90 | Not available in this setting | RVU17A |
| 2016-10-01 | $509.60 | Not available in this setting | RVU16D |
| 2016-07-01 | $509.60 | Not available in this setting | RVU16C |
| 2016-04-01 | $509.60 | Not available in this setting | RVU16B |
| 2016-01-01 | $509.60 | Not available in this setting | RVU16A |
| 2015-10-01 | $504.29 | Not available in this setting | RVU15D |
| 2015-07-01 | $504.29 | Not available in this setting | RVU15C |
| 2015-04-01 | $501.78 | Not available in this setting | RVU15B |
| 2015-01-01 | $501.78 | Not available in this setting | RVU15A |
| 2014-10-01 | $497.56 | Not available in this setting | RVU14D |
| 2014-07-01 | $497.56 | Not available in this setting | RVU14C |
| 2014-04-01 | $497.56 | Not available in this setting | RVU14B |
| 2014-01-01 | $497.56 | Not available in this setting | RVU14A |
| 2013-10-01 | $496.72 | Not available in this setting | RVU13D |
| 2013-07-01 | $496.72 | Not available in this setting | RVU13C |
| 2013-04-01 | $496.72 | Not available in this setting | RVU13B |
| 2013-01-01 | $496.72 | Not available in this setting | RVU13AR |
Where the North Dakota rate applies
North Dakota is a Medicare payment area, not a city. Our Census mapping connects it to 406 cities and communities in North Dakota. Some span more than one payment area; confirm with the service ZIP.
- Abercrombie
- Adams
- Alamo
- Alexander
- Alice
- Almont
- Alsen
- Ambrose
77338 billing questions
How is 77338 distinguished from 77301?
77338 represents the MLC device design for an IMRT plan. 77301 represents the IMRT treatment planning work, including the dose plan; the services describe different parts of planning.
Is 77338 reported per treatment fraction or per plan?
Report it per IMRT plan, rather than once for each delivered fraction.
Which modifier identifies each component?
Use modifier 26 for the professional component and modifier TC for the technical component. Submit without a component modifier for the global service.
Does 77338 include the IMRT dose calculation?
No. It describes MLC device design; the dose-planning work is represented separately when applicable and documented.
What documentation supports 77338?
The record should identify the IMRT plan and show the MLC design work performed for that plan. It should support the per-plan unit reported.
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
Show the CMS file lines behind this rate
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