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See a sample rate comparisonCPT 77263 Fee Schedule
Medicare rates as of October 2026
CPT 77263 is classified under Radiology Procedures, in the Radiation Oncology Treatment subgroup.
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 | 59 - Distinct Procedural Service 26 - Professional component |
| Complexity Level | Moderate |
| Medicare Fee Schedule | $168.34 national non-facility rate (2026) · View Medicare rates for 77263 |
| Medicaid Fee Schedule | $137.20 median of the 8 states in the free preview · View Medicaid rates for 77263 |
National average reimbursement for CPT 77263 by major payers:
$231.61
BCBS / Anthem
$202.42
UnitedHealthcare
$215.86
Aetna
$247.36
Cigna
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CPT 77263
5 of 25 sample ratesHigher to lower in this preview
Sarah Kempel
Duke University Health System Inc
$405.92Published rateLoretta Phillips
Duke Health Integrated Practice Inc
$364.47Published rateKristina Breedlove
Duke Health Integrated Practice Inc
$364.47Published rateAmanda Faulkner
Duke Health Integrated Practice Inc
$364.47Published rateDaniel Simmons
Duke University Health System Inc
$239.78Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 77263 vs. Other Radiation Oncology Treatment Codes
The table lists codes related to 77263. Select one to see its fee schedule.
| 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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Frequently Asked Questions
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.
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.
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.
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.
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.