$242.18
Use 77280 when the simulation meets simple-complexity criteria; 77285 represents the intermediate level.
On this page
CMS RVU26D · Effective 2026-10-01
77285 Radiotherapy simulation Medicare reimbursement rates in Kentucky
Reports intermediate-complexity simulation for radiation treatment, where imaging and setup establish the patient's position and treatment-field arrangement. Compare 77285 office and facility rates across CMS payment localities in Kentucky.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 77285 in Kentucky?
Kentucky has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$406.48
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Radiation oncology
About 77285: Intermediate radiotherapy field simulation
Reports intermediate-complexity simulation for radiation treatment, where imaging and setup establish the patient's position and treatment-field arrangement.
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.
CMS billing rules for 77285
- Professional and technical components
- Diagnostic test with a professional component (modifier 26, interpretation) and a technical component (modifier TC, equipment and staff); billing without a modifier is the global service.
Where the value comes from
- Work RVU1.02 · 8%
- Practice expense (office) RVU12.48 · 92%
- Malpractice RVU0.06 · 0%
12.8K
Medicare services in 2024 · #1344 by national volume
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.
77285 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$398.27
Use 77290 when the simulation meets complex criteria. The distinction is the complexity of the simulation, not simply the number of fields.
$102.65
77262 represents intermediate therapeutic radiology treatment planning. 77285 represents simulation work that establishes the treatment setup and field arrangement.
Compare 77285 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Kentucky →
Office / nonfacility
$406.48
Facility
Unavailable
Need rates for a whole code list?
Fee-sheet and API access are in early access. Tell us which codes and locations your team needs.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 77285 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
9,032
- Code
- 77285
- Physician work
- 1.02
- Practice expense
- 12.48
- Malpractice
- 0.06
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.02 | × 1.000 | 1.0200 |
| Practice expense | 12.48 | × 0.889 | 11.0947 |
| Malpractice | 0.06 | × 0.915 | 0.0549 |
| Total RVUs | 12.1696 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$406.48
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.02 | 1 |
| Practice expense | 12.48 | 0.889 |
| Malpractice | 0.06 | 0.915 |
(1.02 × 1 + 12.48 × 0.889 + 0.06 × 0.915) × $33.4009 = $406.48
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
9,02977280,,Ther rad simulaj field smpl,A,,0.68,7.35,,7.35,NA,0.04,8.07,8.07,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03077280,26,Ther rad simulaj field smpl,A,,0.68,0.40,,0.40,,0.03,1.11,1.11,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03177280,TC,Ther rad simulaj field smpl,A,,0.00,6.95,,6.95,NA,0.01,6.96,6.96,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03277285,,Ther rad simulaj field intrm,A,,1.02,12.48,,12.48,NA,0.06,13.56,13.56,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03377285,26,Ther rad simulaj field intrm,A,,1.02,0.61,,0.61,,0.04,1.67,1.67,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03477285,TC,Ther rad simulaj field intrm,A,,0.00,11.87,,11.87,NA,0.02,11.89,11.89,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
9,03577290,,Ther rad simulaj field cplx,A,,1.52,11.60,,11.60,NA,0.10,13.22,13.22,1,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631