Billing code 77295: Radiotherapy planMedicare rate & RVUs in Florida
Report this service for a three-dimensional radiation therapy plan that models the target and nearby normal tissues to guide dose delivery.
Medicare pays $474.67–$511.91 for 77295 in the office in Florida, from Rest Of Florida to Miami. 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.
On this page 9 sections
What 77295 covers
A radiation oncology team uses imaging data to map the treatment target and surrounding structures, arrange radiation beams, and calculate how the planned dose is distributed in three dimensions. The plan may include dose-volume analysis to assess target coverage and exposure to nearby organs at risk. Radiation oncologists and medical physicists typically develop or review the plan as part of external-beam treatment planning.
Select this code when the documented work supports a three-dimensional plan, rather than a treatment-planning complexity level or a simulation service. Records should support the modeled anatomy, planned beam arrangement, dose calculations, and dose-volume analysis. CMS recognizes professional and technical components: report modifier 26 for the professional interpretation, modifier TC for the technical work and resources, or no component modifier for the global service. The professional and technical components are separately priced by CMS.
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 77295 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$474.67 to $511.91
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | $496.45 | Unavailable |
| Miami | $511.91 | Unavailable |
| Rest Of Florida | $474.67 | Unavailable |
How the 77295 rate is calculated
Each of 77295’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 · 77295
RVUs × geographic indexes × conversion factor
Work4.18
4.18 RVUs× 1.000 GPCI
Practice expense10.10
10.10 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
14.5300
Conversion factor
$33.4009
Medicare rate
$485.32
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77295
The CMS indicators that decide how 77295 is paid alongside other services.
CMS payment indicators · 77295
Radiotherapy 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
77295 without 26 · national office
$485.32
Radiotherapy plan
77295-26 · Professional component
$224.79
Pays only the interpretation and report.
77295 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 77263Treatment planning
- 77263 identifies complex treatment-planning work by complexity level. Use 77295 when the service is a three-dimensional plan with modeled dose distribution.
- 77290Radiation simulation
- 77290 covers complex treatment simulation and field setup. It does not represent development of the three-dimensional dose plan.
- 77301IMRT planning
- 77301 is for intensity-modulated radiotherapy planning. 77295 describes three-dimensional radiotherapy planning by a different method.
77295 billing questions
How is this different from 77263?
77295 represents a three-dimensional radiation plan. Code 77263 describes a treatment-planning complexity level; select based on the service documented rather than treating the codes as interchangeable.
Is this the same service as simulation under 77290?
No. Simulation establishes or verifies treatment setup and fields; 77295 covers development of the three-dimensional plan. The services may be part of the same treatment-planning process.
Which modifier should be used for a split-component claim?
Use modifier 26 for the professional interpretation or modifier TC for the technical portion. Submit without either modifier when billing the global service.
What documentation supports reporting 77295?
The record should support three-dimensional modeling of the target and surrounding anatomy, planned beam arrangement, dose calculations, and dose-volume analysis.
How does 77295 differ from an IMRT plan?
77295 describes three-dimensional radiotherapy planning. Code 77301 is used for intensity-modulated radiotherapy planning, a distinct planning method.
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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