Billing code 77263: Treatment planningMedicare rate & RVUs in Washington
Reports a radiation oncologist’s complex treatment-planning work, including decisions about treatment approach, target coverage, and dose delivery for a radiation course.
Medicare pays $170.83–$185.18 for 77263 in the office in Washington, from Rest Of Washington to Seattle (King Cnty). 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 77263 covers
A radiation oncologist uses this service to develop a complex external-beam radiation treatment plan. The work can include reviewing the patient’s clinical history and diagnostic studies, defining the treatment target, selecting the treatment approach, and determining how dose will be delivered across the planned course. It is reported when the physician’s planning work is complex, such as when multiple treatment areas, modalities, or demanding dose and field-shaping decisions require substantial analysis. Complexity is supported by the documented planning work, not by the diagnosis or body site alone.
Report 77263 for the physician’s planning service, not for each radiation fraction delivered. The record should describe the treatment approach and the specific factors that make the planning complex, such as the areas treated, modalities considered, and dose or field decisions. CMS identifies this as a professional-component-only code for interpretation and report; a separate code covers the technical portion. Simulation and three-dimensional planning are distinct services and should be reported separately when performed and supported by their own documentation.
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 77263 pays more and less in Washington
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Washington | $170.83 | $170.83 |
| Seattle (King Cnty) | $185.18 | $185.18 |
How the 77263 rate is calculated
Each of 77263’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 · 77263
RVUs × geographic indexes × conversion factor
Work3.06
3.06 RVUs× 1.000 GPCI
Practice expense1.74
1.74 RVUs× 1.000 GPCI
Malpractice0.24
0.24 RVUs× 1.000 GPCI
Adjusted RVUs
5.0400
Conversion factor
$33.4009
Medicare rate
$168.34
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 77263
The CMS indicators that decide how 77263 is paid alongside other services.
CMS payment indicators · 77263
Treatment planning
| 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 | 2 | Professional component only. |
77263 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 77261Radiation planning
- 77261 is for simple treatment planning. Choose 77263 only when the documented planning decisions and work support the complex level.
- 77262Radiation planning
- 77262 represents intermediate planning; 77263 represents complex planning. The record should explain the planning demands supporting the higher level.
- 77290Radiation simulation
- 77290 reports radiation simulation, which establishes treatment setup and geometry. 77263 reports the physician’s complex treatment-planning work.
- 77295Radiotherapy plan
- 77295 reports a three-dimensional radiotherapy plan. It is distinct from the complex treatment-planning service reported with 77263.
77263 billing questions
How does 77263 differ from 77261 and 77262?
These codes represent different levels of treatment-planning complexity. Use 77263 when the documented planning work is complex rather than simple or intermediate; the diagnosis or treatment site alone does not establish the level.
Is 77263 the same service as radiation simulation?
No. Treatment planning determines the approach and dose strategy; simulation establishes treatment geometry and setup. Report simulation separately when performed and documented.
Does 77263 include a three-dimensional radiotherapy plan?
The planning service and a three-dimensional radiotherapy plan are distinct. When a separate 3D plan is performed and documented, code 77295 may also be reported.
Should 77263 be billed for every treatment fraction?
No. It reports planning work, not each delivered fraction. Documentation should support the complex planning service for the radiation course.
How should the professional and technical work be reported?
CMS identifies 77263 as professional-component-only for interpretation and report. A separate code covers the technical portion; the record should support the physician’s planning 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 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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