Simple radiation therapy simulation that defines a single treatment area with a single port or parallel opposed ports before radiation is delivered.
- Medicare
- $269.55
- Work RVU
- 0.68
- Global, days
- Region
- Hip
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Referral from the surgeon with indication for radiation
- Risk factors for heterotopic ossification documented in the surgical record
- Single treatment area defined
- Port arrangement and field setup
- Physician supervision and sign-off on the simulation
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 2 cited references ↓
Radiation oncology bills 77280, not orthopedics. It shows up in an ortho patient's chart in one familiar situation: radiation to prevent heterotopic ossification after hip arthroplasty or acetabular fracture fixation in a high-risk patient. A single dose is given shortly before or soon after surgery, and a simple simulation sets up the field.
The ortho practice's job is the referral and the timing. Radiation for HO prophylaxis works only in a narrow window around surgery, so the surgeon's note needs to state the risk factors (prior HO, ankylosing spondylitis, DISH, hypertrophic osteoarthritis) and the reason for prophylaxis. That documentation is what the radiation oncologist and the payer will rely on.
On the radiation oncology side, simulation complexity has to match what was done. A simple simulation is one treatment area. Billing the intermediate or complex level without matching documentation is a common audit finding.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.68) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (8.07) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.68 |
| Practice expense RVU | 7.35 |
| Malpractice RVU | 0.04 |
| Total RVU | 8.07 |
| Medicare national rate | $269.55 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $269.55 |
HOPD (APC 5611) Hospital outpatient department | $137.32 |
Common denial reasons
The recurring reasons claims for CPT 77280 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Simulation level not supported by the documented number of treatment areas
- Indication for prophylactic radiation not documented
- Prior authorization not obtained for radiation therapy
- Global billed in a hospital setting without component split
- Timing outside the window where HO prophylaxis is considered appropriate
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01Does an orthopedic surgeon bill 77280?
02What ortho cases lead to radiation simulation?
03What is the difference between 77280 and 77285?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
Mira Scribe
Mira Scribe captures heterotopic ossification risk factors in the pre-op visit, so the referral for prophylactic radiation carries its own justification.
See how Mira captures CPT 77280 documentation