Billing code 77290: Radiation simulationMedicare rate & RVUs in Utah
Reports complex radiation treatment simulation used to establish patient positioning and treatment fields before delivery of a radiation therapy course.
Medicare pays $417.97 for 77290 in the office in Utah (Utah). 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 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.
77290 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $417.97 | Unavailable |
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.
How the rate is built · 77290
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.52Practice expense 11.60Malpractice 0.10
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 77290
The CMS indicators that decide how 77290 is paid alongside other services.
CMS payment indicators · 77290
Radiation simulation
| 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
77290 without 26 · national office
$441.56
Radiation simulation
77290-26 · Professional component
$81.83
Pays only the interpretation and report.
77290 compared with similar codes
Compare codes
77290 vs 77280 vs 77285 vs 77295 vs 77263: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 77280Radiation simulation
- Use 77280 for a simple simulation setup; 77290 requires documentation supporting a complex setup and field arrangement.
- 77285Radiotherapy simulation
- Use 77285 for intermediate simulation complexity. Choose 77290 when the documented simulation and field arrangement meet the complex level.
- 77295Radiotherapy plan
- 77290 covers simulation and treatment-field setup; 77295 describes development of a three-dimensional radiation treatment plan.
- 77263Treatment planning
- 77263 represents complex treatment-planning evaluation, whereas 77290 reports the simulation used to establish the treatment setup and fields.
77290 billing questions
How does 77290 differ from 77280 or 77285?
The three codes distinguish simulation complexity. Use 77290 when the documented setup and field arrangement are complex rather than simple or intermediate.
Does 77290 include three-dimensional treatment planning?
No. 77290 describes the simulation service, while 77295 represents three-dimensional treatment planning. Report each when its distinct work is performed and documented.
When should modifier 26 or TC be used?
Use modifier 26 for the professional interpretation and modifier TC for the technical portion involving equipment and staff. Without either modifier, the claim represents the global service.
What documentation supports the complex level?
Document the patient setup, imaging or positioning aids, and treatment-field arrangement that make the simulation complex. The record should show why the setup is beyond a simple or intermediate simulation.
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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