How much does Medicare pay for CPT 77263?

Medicare allowed an average of $164.97 per service and paid $129.79 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $788.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 77263?

Complex radiation therapy planning. It was billed 283,548 times to 265,819 Medicare beneficiaries by 4,455 providers in 2024.

Does 77263 pay differently in an office than a hospital?

Yes. The allowed amount averaged $165.76 in an office setting and $164.43 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 77263 most?

Radiation Oncology, with 279,180 services from 4,349 clinicians. Next are Diagnostic Radiology, Dermatology, Radiation Therapy Center.

CPT 77263

Complex radiation therapy planning

$164.97Medicare-allowed amount per service, averaged across 283,548 services

Providers submitted

$788.43

Asking price, not received

Medicare allowed

$164.97

The fee schedule figure

Medicare paid

$129.79

Balance is patient coinsurance

Providers submitted an average of $788.43 for this code and Medicare allowed $164.97 — 4.8× 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 $129.79 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $165.76
Hospital / facility: $164.43

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 114,697 services were billed in an office setting and 168,851 in a facility.

Services: 283,548
Beneficiaries: 265,819
Providers billing it: 4,455
Total allowed: $46,776,914

What Medicare pays for CPT 77263

Across 283,548 services billed by 4,455 providers to 265,819 beneficiaries, Medicare allowed an average of $164.97 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 77263

Specialty	Services	Beneficiaries	Avg allowed	Providers
Radiation Oncology	279,180	262,037	$164.94	4,349
Diagnostic Radiology	1,729	1,478	$168.12	34
Dermatology	873	797	$167.24	38
Radiation Therapy Center	398	371	$165.21	3
Hematology-Oncology	386	362	$166.16	6
Internal Medicine	301	217	$166.55	3
Interventional Radiology	188	156	$167.01	11
Pediatric Medicine	176	155	$180.50	2
Micrographic Dermatologic Surgery	125	91	$165.03	2
Nuclear Medicine	47	33	$162.87	2
Otolaryngology	34	28	$154.86	1
Gynecological Oncology	33	32	$159.27	1
Physician Assistant	31	19	$139.89	1
Nurse Practitioner	26	22	$139.98	1
Pathology	21	21	$157.54	1

77263 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	28,237	$176.88	$128.27	424
Florida	25,703	$166.22	$127.58	364
Texas	19,370	$159.97	$127.58	292
New York	15,876	$180.26	$128.33	285
Pennsylvania	14,117	$161.94	$127.44	259
Illinois	11,106	$169.83	$128.69	176
Ohio	10,585	$160.02	$128.27	190
Massachusetts	8,976	$172.32	$127.56	150
North Carolina	8,918	$157.52	$128.51	149
New Jersey	7,963	$174.79	$128.15	102
Arizona	7,826	$161.17	$128.04	107
Virginia	7,729	$163.57	$127.69	82
Tennessee	7,460	$154.06	$128.30	92
Georgia	7,262	$160.11	$127.94	124
Michigan	7,003	$162.28	$128.41	149
Maryland	6,472	$169.98	$128.30	84
Washington	6,089	$168.82	$129.15	114
Indiana	5,742	$154.67	$129.15	83
Missouri	5,712	$158.03	$127.60	89
South Carolina	5,124	$157.03	$127.30	59
Wisconsin	5,103	$158.60	$128.38	109
Minnesota	5,038	$162.78	$128.54	102
Colorado	4,447	$163.05	$127.70	75
Alabama	3,843	$156.54	$127.96	67
Kansas	3,674	$154.36	$127.89	39
Kentucky	3,468	$157.82	$128.41	58
Louisiana	3,248	$157.75	$128.08	49
Arkansas	2,937	$154.16	$128.36	34
Oregon	2,915	$164.73	$128.85	65
Oklahoma	2,859	$156.07	$128.57	32
Connecticut	2,630	$173.72	$128.34	60
Iowa	2,570	$154.84	$129.03	35
Mississippi	2,451	$153.49	$127.63	28
Nebraska	1,956	$150.74	$127.10	25
New Hampshire	1,745	$159.37	$128.58	27
Nevada	1,674	$163.83	$128.24	29
Utah	1,528	$162.06	$129.17	30
Idaho	1,508	$155.22	$127.93	17
Delaware	1,374	$161.87	$125.87	15
West Virginia	1,270	$158.60	$126.94	23
Montana	1,245	$163.99	$129.51	15
South Dakota	1,217	$158.45	$129.48	15
District of Columbia	1,111	$178.02	$127.95	18
Rhode Island	1,084	$167.40	$128.19	21
North Dakota	951	$165.40	$129.19	15
New Mexico	929	$162.64	$128.45	16
Alaska	916	$206.15	$129.27	12
Maine	772	$159.67	$129.98	15
Hawaii	704	$164.14	$127.82	17
Vermont	681	$165.39	$127.27	10
Wyoming	350	$167.68	$129.79	5
Guam	50	$166.16	$120.49	1
Puerto Rico	30	$160.31	$125.82	2

Related codes

77280Obtaining data needed to develop the optimal radiation treatment$227.81
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
77261Simple radiation therapy planning$69.44
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.