Intermediate radiation therapy simulation used to set up treatment fields, generally covering two separate treatment areas before radiation delivery.
- Medicare
- $452.92
- Work RVU
- 1.02
- Global, days
- Region
- Multi-region
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 2 cited references ↓
- Referral and indication for radiation
- Two separate treatment areas identified
- Field setup and port arrangement for each area
- Relevant surgical history, such as fixation hardware in the field
- Physician supervision and sign-off
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 ↓
Intermediate simulation (77285) is billed by radiation oncology when the plan involves two separate treatment areas. In orthopedic patients this comes up with metastatic bone disease: a patient with a pathologic femur fracture fixed by the ortho team who also needs palliative radiation to a second painful site, such as the spine.
Radiation after fixation of a metastatic lesion is common practice, and the ortho surgeon's operative note and follow-up note are part of that record. The note should name the lesion, the hardware placed, and that radiation is planned. Radiation oncology uses it to define the field around the implant.
On the billing side, the simulation level has to match the number of areas and the complexity documented. One area billed as intermediate is a frequent audit target. Most commercial plans require prior authorization for the radiation course, and simulation is often reviewed as part of that.
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 (1.02) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (13.56) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 1.02 |
| Practice expense RVU | 12.48 |
| Malpractice RVU | 0.06 |
| Total RVU | 13.56 |
| Medicare national rate | $452.92 |
| 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 | $452.92 |
HOPD (APC 5612) Hospital outpatient department | $382.54 |
Common denial reasons
The recurring reasons claims for CPT 77285 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Only one treatment area documented
- Radiation course not authorized
- Simulation billed more often than the treatment plan supports
- Global billed in a facility setting
- Missing physician sign-off
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 2 cited references ↓
01When is 77285 used instead of 77280?
02Does orthopedics bill radiation simulation?
03Does radiation simulation need prior authorization?
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 documents the lesion site, fixation hardware, and plan for radiation in the post-op note, giving radiation oncology a clear handoff.
See how Mira captures CPT 77285 documentation