Billing code 77280: Radiation simulationMedicare rate & RVUs

Medicare pays $269.55 for 77280 nationally in the office. Local office rates run $234.28–$379.93.

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

What 77280 covers

The radiation oncology team uses a simulator or treatment imaging system to reproduce the patient’s treatment position and establish basic beam geometry for a simple field setup. The radiation oncologist directs and interprets the simulation; radiation therapists commonly assist with positioning and image acquisition in a radiation oncology department. The service supports accurate setup before treatment begins or when a new setup is needed.

Select 77280 when the documented field-setting work meets the simple level; use 77285 or 77290 when the simulation complexity supports those levels. Documentation should identify the treatment site, patient position, field geometry, simulation images, and physician involvement. CMS recognizes modifier 26 for the professional component and modifier TC for the technical component; 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 77280 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

77280 rates by state

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

How the 77280 rate is calculated

Each of 77280’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 77280

The CMS indicators that decide how 77280 is paid alongside other services.

What modifiers do to the payment

When to use modifier 26

77280 compared with similar codes

How to choose

77285Radiotherapy simulation

77285 represents intermediate simulation complexity. Choose it instead of 77280 when the documented field-setting work supports that level.

77290Radiation simulation

77290 represents complex simulation work, rather than the simple setup reported with 77280. The documentation should support the higher complexity.

77261Radiation planning

77261 describes simple radiation treatment planning, not simulator-based field setup. Report it for distinct planning work rather than as a substitute for 77280.

Codes related to 77280

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