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2025 CPT code 77261

Therapeutic radiology treatment planning; simple.

Follow all applicable CPT coding guidelines and payer-specific rules for radiation oncology services.

Modifiers 52 (reduced services), 59 (distinct procedural service), 76 (repeat procedure), and others may be applicable depending on the specific circumstances of the procedure and payer requirements. Consult the appropriate coding guidelines for details on the correct application of each modifier.

Medical necessity for radiation therapy treatment planning is established when a patient has a malignant or benign tumor that is amenable to radiation therapy, and the planned treatment is deemed clinically appropriate to manage the disease, improve symptoms, or enhance the patient's quality of life. Supporting medical record documentation should show the need for radiation therapy and the clinical rationale behind the chosen treatment plan.

The physician's responsibilities include reviewing diagnostic images, determining the target volume and surrounding healthy tissue, selecting the appropriate radiation modality and dosage, planning the treatment beams, and ensuring proper shielding to minimize damage to healthy tissues.

IMPORTANT For more complex planning, consider codes 77262 and 77263.If the service is not listed, use an unlisted procedure code (77299, 77399, 77499, or 77799) with a detailed special report.

In simple words: This code covers the basic planning for radiation treatment of a tumor.The doctor figures out where to aim the radiation beams and how much to use, keeping it simple and avoiding complicated techniques.

This CPT code encompasses the creation of a simple radiation therapy treatment plan.The plan involves a single treatment area, utilizing superficial orthovoltage, cobalt, linear accelerator, or photon treatments.It requires minimal to no blocking and does not involve interpretation of special tests for tumor localization. The volume of interest is encompassed within simple portal arrangements, such as a single port or simple parallel opposed ports.

Example 1: A patient with a small, superficial skin lesion requiring simple external beam radiation. A single treatment port is sufficient, and no complex blocking is needed., A patient with a localized prostate cancer undergoing external beam radiation therapy. The treatment plan involves simple parallel opposed fields with minimal shielding., A patient with early-stage breast cancer receiving external beam radiation. Treatment planning involves a simple tangential field arrangement for a single treatment area.

* Physician’s orders specifying the radiation therapy.* Diagnostic imaging studies (e.g., CT, MRI) delineating the tumor and surrounding structures.* Treatment plan outlining the radiation dose, field arrangement, and shielding.* Documentation of the treatment simulation process.

** This code is specifically for simple treatment planning.More complex planning scenarios, such as those involving multiple treatment areas, arc therapy, or brachytherapy, require the use of different CPT codes. Always ensure thorough documentation of the treatment plan and its rationale to support the medical necessity of the service and accurate reimbursement.

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