What is CPT code 77263?

CPT 77263 is used for Therapeutic Radiology Tx Planning; Complete. It represents a moderate-level medical decision-making encounter, often including multiple diagnoses or prescription management.

What factors affect CPT 77263 fee schedules?

Factors affecting fee schedules include government-set Medicare & Medicaid rates, negotiated private insurance rates, geographic location (costs higher in urban areas), and provider type (e.g., hospital vs. private practice).

How does CPT 77263 compare to other radiation oncology treatment codes?

CPT 77263 represents a moderate-complexity encounter for Therapeutic Radiology Tx Planning. Unlike lower-level codes such as 77261 or 77262, it involves more provider time and moderate medical decision-making, typically including multiple diagnoses or medication management.

Where can I view Medicare rates for CPT 77263?

You can view Medicare rates for CPT 77263 on the PayerPrice website's Medicare Fee Schedule Lookup, providing insights into government-set reimbursement amounts.

How can I find out the cost of a medical procedure?

To understand the potential cost of a medical procedure, you can start by contacting your healthcare provider's billing department for an estimate. You should also check with your health insurance company to understand your coverage, deductible, co-pays, and out-of-pocket maximums. For specific price lookups based on CPT code and location, you can utilize tools like Payerprice.

What is a CPT code and why is it important for understanding medical costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare professionals to report medical, surgical, and diagnostic services to entities like insurance companies. They are crucial for understanding medical costs because they precisely identify the service provided, which allows you to research its price, compare costs, and ensure accurate billing from your provider and proper reimbursement from your insurer.

How does insurance affect the price I pay for medical services?

Your health insurance plan significantly impacts the price you pay. It typically covers a portion of medical costs after you meet your deductible. You may also have co-pays (a fixed amount for a service) or co-insurance (a percentage of the cost) that you are responsible for. The negotiated rates between your insurance company and in-network providers also influence the final cost. Always verify your coverage and benefits with your insurer.

Where can I look up the price for a specific medical service in my area?

To find the price for a specific medical service, especially if you have a CPT code, you can use online tools designed for this purpose. Payerprice offers a fee schedule lookup tool that allows users to search for prices based on CPT code and specific location, providing transparent pricing information.

What is the difference between an in-network and out-of-network provider?

An in-network provider has a contract with your health insurance plan, agreeing to provide services at negotiated rates. This usually means lower out-of-pocket costs for you. An out-of-network provider does not have such a contract. While your insurance might still cover some of the cost, you generally pay a higher percentage or the full difference between the provider's charge and what your insurance covers (balance billing). Always check if a provider is in-network before receiving services to avoid unexpected costs.

CPT 77263 Fee Schedule

Last Verified: September 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Therapeutic Radiology Treatmen, Therapeutic Radiology Treatment Planning Complextherapeutic Radiology Treatment Planning Complex

Key Fact	Detail
Service Type	Radiology Procedures Radiation Oncology Treatment
Common Place of Service	22 - On Campus Outpatient Hospital 11 - Office
Common Modifiers	None 59 - Distinct Procedural Service 26 - Professional component
Complexity Level	Moderate
Medicare Fee Schedule	View Medicare rates for 77263
Medicaid Fee Schedule	View Medicaid rates for 77263

National average reimbursement for CPT 77263 by major payers:

$231.61

$202.42

$215.86

$247.36

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 77263.

CPT 77263

5 of 25 sample ratesHigher to lower in this preview

Sarah Kempel
Duke University Health System Inc
PARegistered NurseNPI 1801436076Tax ID 56-2070036
$405.92Published rate
Loretta Phillips
Duke Health Integrated Practice Inc
NCNurse PractitionerNPI 1790985224Tax ID 86-2109896
$364.47Published rate
Kristina Breedlove
Duke Health Integrated Practice Inc
NCNeonatal Nurse PractitionerNPI 1366533838Tax ID 86-2109896
$364.47Published rate
Amanda Faulkner
Duke Health Integrated Practice Inc
KYAnesthesiology PhysicianNPI 1750795860Tax ID 86-2109896
$364.47Published rate
Daniel Simmons
Duke University Health System Inc
NCCertified Registered Nurse AnesthetistNPI 1851548978Tax ID 56-2070036
$239.78Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 77263 vs. Other Radiation Oncology Treatment Codes

The CPT 77263 code is part of the Radiology Procedures services used for Radiation Oncology Treatment. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 77263 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
77261-CPT	Low	Therapeutic Radiology Treatmen, Therapeutic Radiology Treatment Planning Simpletherapeutic Radiology Treatment Planning Simple
77262-CPT	Low	Therapeutic Radiology Treatmen, Therapeutic Radiology Treatment Planning Intermediatetherapeutic Radiology Treatment Planning Intermediate
77263-CPT	Moderate	Therapeutic Radiology Treatmen, Therapeutic Radiology Treatment Planning Complextherapeutic Radiology Treatment Planning Complex
77300-CPT	Low	Radiation Therapy Dose Plan, Basic Radiation Dosimetry Calculation Central Axis Depth Dose Calculation Tdf Nsd Gap Calculation Off Axis Factor Tissue Inhomogeneity Factors Calculation Of Non Ionizing Radiation Surface And Depth Dose As Required During Course Of Treatment Only When Prescribed By The Treating Physician

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 77263. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 77263 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 77263 Fee Schedule

Sarah Kempel

Loretta Phillips

Kristina Breedlove

Amanda Faulkner

Daniel Simmons