How much does Medicare pay for CPT 77261?

Medicare allowed an average of $69.44 per service and paid $54.78 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $166.63, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 77261?

Simple radiation therapy planning. It was billed 11,464 times to 10,647 Medicare beneficiaries by 260 providers in 2024.

Does 77261 pay differently in an office than a hospital?

Yes. The allowed amount averaged $69.42 in an office setting and $70.05 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 77261 most?

Dermatology, with 9,183 services from 214 clinicians. Next are Radiation Oncology, Micrographic Dermatologic Surgery, Otolaryngology.

CPT 77261

Simple radiation therapy planning

$69.44Medicare-allowed amount per service, averaged across 11,464 services

Providers submitted

$166.63

Asking price, not received

Medicare allowed

$69.44

The fee schedule figure

Medicare paid

$54.78

Balance is patient coinsurance

Providers submitted an average of $166.63 for this code and Medicare allowed $69.44 — 2.4× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $54.78 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $69.42
Hospital / facility: $70.05

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 11,130 services were billed in an office setting and 334 in a facility.

Services: 11,464
Beneficiaries: 10,647
Providers billing it: 260
Total allowed: $796,060

What Medicare pays for CPT 77261

Across 11,464 services billed by 260 providers to 10,647 beneficiaries, Medicare allowed an average of $69.44 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 77261

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	9,183	8,598	$69.45	214
Radiation Oncology	1,046	928	$71.99	24
Micrographic Dermatologic Surgery	304	292	$69.32	7
Otolaryngology	289	259	$65.56	3
Family Practice	266	229	$68.07	4
Interventional Pain Management	164	135	$65.63	1
Pathology	138	135	$66.35	2
Diagnostic Radiology	26	25	$71.26	2
Physician Assistant	20	20	$57.24	1
Internal Medicine	16	15	$65.17	1
Podiatry	12	11	$74.62	1

77261 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,629	$73.27	$53.99	23
Florida	1,511	$69.99	$54.44	25
Texas	930	$69.03	$54.16	17
Illinois	622	$70.37	$53.54	19
North Carolina	588	$68.66	$54.91	14
Indiana	529	$66.92	$54.62	13
Arizona	469	$69.82	$54.79	10
Tennessee	465	$65.29	$54.94	14
South Carolina	434	$67.04	$53.29	8
Georgia	331	$67.94	$54.76	10
Pennsylvania	315	$69.79	$54.07	12
Alabama	314	$64.42	$51.72	7
Iowa	286	$65.41	$53.34	2
Michigan	260	$69.91	$54.55	11
Ohio	254	$68.33	$55.02	8
Delaware	223	$71.27	$50.80	2
Montana	184	$69.25	$54.70	3
Mississippi	174	$66.17	$52.75	4
Virginia	170	$68.29	$54.98	7
New York	169	$75.57	$53.96	3
New Jersey	155	$77.46	$54.00	3
Minnesota	131	$66.15	$54.89	5
Oklahoma	122	$66.19	$53.26	6
Oregon	113	$68.60	$55.13	3
Connecticut	112	$71.95	$53.93	3
Missouri	103	$62.25	$55.05	3
South Dakota	98	$65.76	$53.20	2
New Hampshire	88	$72.54	$54.93	2
West Virginia	87	$70.65	$55.23	1
Louisiana	78	$68.94	$51.69	2
Kentucky	76	$65.82	$54.96	2
Arkansas	69	$64.83	$54.86	2
Wisconsin	64	$66.67	$54.86	2
Colorado	48	$72.13	$54.98	3
Massachusetts	40	$77.51	$55.06	1
New Mexico	38	$66.84	$51.83	1
Washington	37	$68.28	$55.29	1
Alaska	36	$91.03	$54.91	1
Utah	36	$67.96	$54.72	2
Idaho	36	$60.75	$53.46	1
North Dakota	23	$72.17	$54.94	1
Maryland	17	$72.95	$54.91	1

Related codes

77280Obtaining data needed to develop the optimal radiation treatment$227.81
77263Complex radiation therapy planning$164.97
77290Obtaining data needed to develop the optimal radiation treatment$213.71
772953d radiation therapy planning$274.90
77293Obtaining respiratory data needed to develop the optimal radiation tre$168.95
77285Obtaining data needed to develop the optimal radiation treatment$422.93
77262Intermediate radiation therapy planning$106.12

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.