Radiation Oncology IMRT Bundling & Fraction Scrubber

CMS Chapter 13 MPFS and ASTRO guidelines enforce strict NCCI bundling edits between IMRT Planning (CPT 77301), dosimetry (77300), and 3D simulation (77295). In addition, Weekly Radiation Treatment Management (CPT 77427) requires exact 5-fraction increments with specific rules for treatment end remainders. Scrub your planning packages and fraction calculations before claim transmission.

Radiation Oncology Treatment & Physics Scrubber

CMS MPFS Chapter 13 & ASTRO Bundling Standards

Radiation Treatment Modality

Complex multi-segment step-and-shoot or dynamic arc inverse-planned photon therapy.

Treatment Course Fractions28 fractions

SBRT / Hypofractionated (1–5)Standard Curative Course (25–35)Extended Boost (40+)

Planning & Dosimetry Services Billed

CPT 77301 — IMRT Treatment Plan (Inverse Planning)

CPT 77295 — 3D Simulation / Volumetric Reconstruction(NCCI Bundling Collision)

CPT 77300 — Basic Radiation Dosimetry Calculation(NCCI Bundled)

CPT 77338 — Medical Physics MLC Device Design (Separately Payable)

CPT 77334 — Complex Treatment Devices (Mask / Mold / Bolus)

Customized physical mask/mold documented prior to simulation date

ASTRO & CMS Bundling AuditCPT 77427 Rule § 100.1

Planning & Physics:$2,520

Delivery (77386 × 28 fx):$11,760

Weekly Mgmt (77427 × 6 units):+$2,910

Total Expected Course:$17,190

Unbundled Claim Denial Risk:-$765

Services bundled under NCCI PTP edits will be rejected by Medicare MAC with CARC 97.

Weekly Treatment Fraction Math

Final remainder of 3 fractions meets CMS ≥3 rule: generates +1 billable unit of 77427!

77295 Bundled into 77301

NCCI PTP Edit (CARC 97): 3D Simulation (77295) is mutually exclusive with IMRT Planning (77301) when performed for the same course. Denied if billed on same DOS without distinct separate site documentation.

77300 Bundled into 77301

Basic Dosimetry (77300) calculations are intrinsic to IMRT computer optimization algorithms. Standalone billing on plan generation date triggers NCCI bundling denial.

Request Radiation Oncology Audit

ANSI X12 837P Radiation Oncology Claim Segment

Electronic Loop 2400 SV1 Lines with Fraction Unit Multipliers

ISA*00* *00* *ZZ*RADONC-BILLING *ZZ*PAYER-EDI *260905*1200*^*00501*000000003*0*P*:~ GS*HC*RADONC-BILLING*PAYER-EDI*20260905*1200*1*X*005010X222A1~ ST*837*0003*005010X222A1~ BHT*0019*00*20260905003*20260905*1200*CH~ NM1*85*2*METRO CANCER INSTITUTE*****XX*1749204918~ CLM*RO-COURSE-884*17190.00***11:B:1*Y*A*Y*Y~ // LINE 1: PRIMARY PLANNING PROCEDURE LX*1~ SV1*HC:77301*1850.00*UN*1~ DTP*472*D8*20260905~ // LINE 2: MLC DEVICE DESIGN (ASTRO SEPARATELY PAYABLE) LX*2~ SV1*HC:77338*390.00*UN*1~ DTP*472*D8*20260905~ // LINE 3: TREATMENT DELIVERY SESSIONS LX*3~ SV1*HC:77386*11760.00*UN*28~ DTP*472*RD8*20260905-20261014~ // LINE 4: WEEKLY TREATMENT MANAGEMENT (CPT 77427) LX*4~ SV1*HC:77427*2910.00*UN*6~ DTP*472*RD8*20260905-20261014~ SE*16*0003~ GE*1*1~ IEA*1*000000003~

Request Radiation Oncology Coding & Physics Audit

Overcome IMRT planning bundling recoupments, streamline dosimetry capture, and defend proton therapy prior authorizations.

Next Step For Your Practice

Turn these Radiation Oncology Scrubber insights into recovered cash

Frustrated with IMRT bundling denials, medical physics downcoding, or proton therapy prior authorizations? Aethera delivers certified radiation oncology coding specialists who protect revenue across external beam, SBRT, and proton treatments. Let our senior AAPC-certified billing team audit 50 of your active claims or past denials — completely free, with guaranteed under-48-hour findings.

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