How much does Medicare pay for CPT 77290?

Medicare allowed an average of $213.71 per service and paid $169.17 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $775.42, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

Does 77290 pay differently in an office than a hospital?

Yes. The allowed amount averaged $361.67 in an office setting and $81.53 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 77290 most?

Radiation Oncology, with 128,282 services from 3,275 clinicians. Next are Dermatology, Radiation Therapy Center, Diagnostic Radiology.

CPT 77290

Obtaining data needed to develop the optimal radiation treatment, 3 or more treatment areas or any number of treatment areas where special treatment is involved

$213.71Medicare-allowed amount per service, averaged across 144,848 services

Providers submitted

$775.42

Asking price, not received

Medicare allowed

$213.71

The fee schedule figure

Medicare paid

$169.17

Balance is patient coinsurance

Providers submitted an average of $775.42 for this code and Medicare allowed $213.71 — 3.6× 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 $169.17 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $361.67
Hospital / facility: $81.53

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. 68,344 services were billed in an office setting and 76,504 in a facility.

Services: 144,848
Beneficiaries: 120,028
Providers billing it: 3,531
Total allowed: $30,955,466

What Medicare pays for CPT 77290

Across 144,848 services billed by 3,531 providers to 120,028 beneficiaries, Medicare allowed an average of $213.71 per service. That is 1.2 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 77290

Specialty	Services	Beneficiaries	Avg allowed	Providers
Radiation Oncology	128,282	108,439	$187.77	3,275
Dermatology	12,206	8,000	$450.75	158
Radiation Therapy Center	1,089	934	$358.73	15
Diagnostic Radiology	882	660	$228.09	24
Micrographic Dermatologic Surgery	411	361	$378.82	10
General Surgery	297	242	$396.17	1
Internal Medicine	252	167	$450.75	5
Family Practice	214	196	$401.03	5
Physician Assistant	206	173	$359.45	6
Hematology-Oncology	185	169	$122.18	6
Interventional Radiology	174	133	$81.36	9
Pediatric Medicine	171	149	$88.75	1
Ambulatory Surgical Center	103	103	$206.24	3
Nurse Practitioner	101	88	$360.82	4
General Practice	86	55	$440.01	2

77290 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	18,121	$286.75	$196.42	349
Florida	16,785	$332.07	$266.35	320
Texas	7,782	$283.84	$231.19	217
Pennsylvania	6,796	$121.90	$96.46	191
New York	6,277	$155.00	$110.54	191
New Jersey	5,791	$203.12	$141.32	90
Illinois	5,529	$133.59	$103.20	151
Arizona	5,449	$364.49	$290.84	100
Ohio	4,494	$234.49	$164.66	132
Tennessee	4,178	$167.23	$144.02	70
Massachusetts	3,803	$108.94	$81.27	110
Maryland	3,585	$230.92	$172.59	76
Washington	3,425	$215.75	$162.10	99
Virginia	3,404	$164.44	$126.73	78
Georgia	3,156	$168.62	$141.24	104
Michigan	3,140	$125.50	$102.19	111
North Carolina	3,096	$142.78	$118.34	100
Indiana	2,900	$146.09	$122.49	75
Missouri	2,540	$105.96	$88.37	68
South Carolina	2,242	$219.14	$179.88	52
Oklahoma	2,175	$165.47	$142.39	31
Kentucky	1,846	$154.74	$129.31	54
Wisconsin	1,827	$110.93	$88.63	73
Louisiana	1,705	$232.47	$201.06	43
Delaware	1,649	$265.03	$206.56	15
Alabama	1,645	$247.99	$212.24	43
Minnesota	1,645	$154.44	$119.29	70
Arkansas	1,488	$208.23	$188.24	31
Colorado	1,464	$140.09	$107.63	58
Oregon	1,406	$199.78	$154.68	51
Kansas	1,364	$132.93	$111.33	27
Connecticut	1,315	$117.40	$86.52	44
Mississippi	1,308	$133.25	$117.53	25
Iowa	1,211	$85.47	$70.44	27
Nebraska	1,097	$198.92	$169.55	21
Nevada	1,037	$259.33	$202.34	23
New Hampshire	990	$147.35	$113.63	23
Idaho	748	$138.12	$116.44	18
Maine	742	$98.67	$81.12	17
Utah	723	$135.93	$113.17	24
Montana	598	$99.38	$78.31	16
West Virginia	589	$137.55	$115.37	13
District of Columbia	585	$110.32	$80.45	16
South Dakota	531	$78.55	$63.04	12
Rhode Island	490	$181.24	$138.07	17
Alaska	475	$208.28	$145.34	11
Vermont	413	$100.81	$77.71	10
Hawaii	393	$214.27	$159.31	10
New Mexico	348	$236.23	$201.30	12
North Dakota	346	$271.81	$205.62	9
Wyoming	202	$156.80	$119.01	3

Related codes

77280Obtaining data needed to develop the optimal radiation treatment$227.81
77263Complex radiation therapy planning$164.97
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.