How much does Medicare pay for CPT 77280?

Medicare allowed an average of $227.81 per service and paid $181.14 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $523.40, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 77280?

Obtaining data needed to develop the optimal radiation treatment, 1 treatment area. It was billed 508,830 times to 113,640 Medicare beneficiaries by 3,320 providers in 2024.

Does 77280 pay differently in an office than a hospital?

Yes. The allowed amount averaged $255.87 in an office setting and $37.15 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 77280 most?

Dermatology, with 334,377 services from 407 clinicians. Next are Radiation Oncology, Micrographic Dermatologic Surgery, Otolaryngology.

CPT 77280

Obtaining data needed to develop the optimal radiation treatment, 1 treatment area

$227.81Medicare-allowed amount per service, averaged across 508,830 services

Providers submitted

$523.40

Asking price, not received

Medicare allowed

$227.81

The fee schedule figure

Medicare paid

$181.14

Balance is patient coinsurance

Providers submitted an average of $523.40 for this code and Medicare allowed $227.81 — 2.3× 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 $181.14 (80%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $255.87
Hospital / facility: $37.15

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. 443,560 services were billed in an office setting and 65,270 in a facility.

Services: 508,830
Beneficiaries: 113,640
Providers billing it: 3,320
Total allowed: $115,916,562

What Medicare pays for CPT 77280

Across 508,830 services billed by 3,320 providers to 113,640 beneficiaries, Medicare allowed an average of $227.81 per service. That is 4.5 services per beneficiary, so this is a code patients typically receive more than once. 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 77280

Specialty	Services	Beneficiaries	Avg allowed	Providers
Dermatology	334,377	23,368	$263.54	407
Radiation Oncology	126,990	84,581	$127.72	2,775
Micrographic Dermatologic Surgery	11,520	809	$249.16	16
Otolaryngology	8,519	437	$243.64	5
Family Practice	5,666	557	$244.14	11
Pathology	4,537	262	$243.66	3
Interventional Pain Management	3,651	165	$242.58	1
Physician Assistant	3,163	909	$221.07	29
Internal Medicine	2,494	283	$278.24	8
General Surgery	1,552	235	$237.19	1
Plastic and Reconstructive Surgery	1,486	115	$253.23	6
General Practice	1,117	45	$312.81	1
Radiation Therapy Center	978	758	$228.92	17
Nurse Practitioner	859	278	$225.84	12
Cardiac Surgery	582	49	$235.60	1

77280 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	69,857	$275.98	$191.60	328
Florida	59,657	$243.66	$196.82	309
Texas	41,136	$245.00	$200.44	186
Illinois	25,056	$223.13	$179.86	148
Arizona	20,769	$255.87	$201.23	98
Indiana	19,732	$225.56	$189.89	86
North Carolina	18,620	$221.19	$182.46	115
Pennsylvania	18,158	$184.15	$144.58	201
South Carolina	16,686	$230.88	$195.72	55
Georgia	15,702	$215.98	$182.01	105
Tennessee	15,050	$209.56	$184.09	78
Alabama	14,311	$222.25	$200.49	48
New Jersey	11,922	$211.28	$144.27	80
Michigan	10,546	$191.00	$157.81	100
Ohio	10,422	$204.68	$164.01	124
Iowa	10,100	$204.40	$176.58	33
Oklahoma	8,935	$213.14	$184.36	40
Virginia	8,346	$189.01	$146.69	74
Kentucky	8,075	$211.45	$183.27	46
Missouri	7,906	$171.15	$152.46	66
Mississippi	7,863	$203.13	$183.59	26
New York	7,730	$211.17	$146.70	139
Minnesota	6,907	$249.34	$195.80	38
Oregon	6,867	$240.33	$188.87	47
Washington	6,485	$212.24	$161.73	85
Montana	6,027	$250.67	$197.40	15
Louisiana	5,902	$223.53	$189.52	40
Delaware	5,885	$246.77	$190.07	13
Wisconsin	4,491	$202.89	$169.45	50
Connecticut	4,448	$210.54	$155.05	48
Massachusetts	4,443	$101.26	$69.93	94
South Dakota	3,563	$228.54	$180.22	16
Maryland	3,229	$127.20	$96.46	70
Arkansas	2,884	$194.82	$175.65	28
Colorado	2,849	$199.49	$148.56	53
West Virginia	2,846	$218.57	$170.56	18
Utah	2,342	$209.41	$173.22	25
Alaska	2,135	$252.68	$181.96	15
Idaho	1,694	$197.36	$180.94	13
New Mexico	1,652	$228.56	$193.35	11
Nevada	1,598	$152.93	$120.35	24
North Dakota	1,495	$236.13	$176.76	11
New Hampshire	946	$120.79	$90.89	23
Kansas	899	$90.86	$76.35	24
Nebraska	851	$121.02	$103.72	18
Hawaii	433	$140.96	$100.80	12
Rhode Island	417	$110.51	$87.39	13
District of Columbia	307	$80.60	$57.57	10
Maine	266	$51.00	$42.76	12
Wyoming	205	$96.37	$72.16	3
Vermont	169	$63.47	$47.90	5
Puerto Rico	16	$265.66	$210.22	1

Related codes

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
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.