Exploring radiation oncology procedures by volume and charges 

Physicians have used ionizing radiation to treat cancer since 1896—only a year after X-rays were discovered by Wilhelm Röntgen.

The radiation therapies used in radiation oncology aim to damage cancer cells’ DNA, slowing or preventing tumors from growing and, in some cases, eliminating tumors entirely.

As the medical use of radiation has become safer and more precise, patients have access to a growing variety of palliative and curative radiation oncology procedures. Unfortunately, this heightened demand has also created a deficit of physicians within the field of radiation oncology.

The charts below show the radiation oncology procedures performed most frequently during 2021, as well as those with the highest total charges.

Top 10 radiation oncology procedures by volume

Rank HCPCS/CPT Code HCPCS/CPT Description # Total Procedures
1 77427 Radiation treatment management (5 treatments) 66,596
2 77336 Medical radiation physics consultation 46,683
3 77334 Radiation treatment aid(s) 27,116
4 77523 Proton beam radiation treatment, intermediate 26,847
5 77300 Radiation therapy dose planning 21,227
6 77263 Radiation therapy planning 17,985
7 77280 Radiation therapy field simulation, 1 treatment area 13,793
8 77290 Radiation therapy field simulation, 3+ treatment areas 13,061
9 77338 Multi-leaf collimator device for IMRT 10,962
10 77387 Guidance for radiation therapy delivery 10,723

Fig 1. Data from Definitive Healthcare’s platform on commercial claims analytics. Top CPT codes are from imaging center reports from CY 2021 and include radiation oncology procedures.

Most common radiation oncology procedures by volume

Radiation treatment management (5 treatments) was the most commonly performed radiation oncology procedure in 2021, with 66,596 procedures reported. This procedure code is reported once for every five treatment sessions a patient receives. Typically, these sessions include a medical examination, a review of therapy dosage and reviews of lab and imaging results.

The next most common procedure, the medical radiation physics consultation, is a technical service performed by a radiation physicist as part of a routine treatment plan. During this procedure, the radiation physicist reviews a patient’s treatment chart and record to ensure the radiation oncologist’s prescribed dosage, delivery specifications and safety considerations are being followed.

The radiation treatment aid(s) procedure ranks third by total 2021 procedures. This procedure code is reported when a patient requires a customized treatment device to be made for their oncology treatment. These can include wax molds designed for a specific body part, custom-made eye shields and immobilizing/restraining devices.

Top 10 radiation oncology procedures by total charges

Rank HCPCS/CPT Code HCPCS/CPT Description Total Charges
1 77523 Proton beam radiation treatment, intermediate $133,633,609
2 77427
Radiation treatment management (5 treatments)
$41,704,736
3 77301 Radiation therapy dose planning for IMRT $36,150,303
4 77334 Radiation treatment aid(s) $18,550,260
5 77336 Medical radiation physics consultation $14,682,656
6 77373 SBRT delivery $14,495,827
7 77295 3-D radiotherapy planning $13,423,577
8 77300
Radiation therapy dose planning
$12,939,721
9 77290
Radiation therapy field simulation, 3+ treatment areas
$12,842,426
10 77338 Multi-leaf collimator device for IMRT $12,514,936

Fig 2. Data from Definitive Healthcare’s platform on commercial claims analytics. Top CPT codes are from imaging center reports from CY 2021 and include radiation oncology procedures.

Most common radiation oncology procedures by total charges

With over $133 million in total charges—more than three times the total charges of the runner-up—proton beam radiation treatment delivery (intermediate) had the greatest total charges in 2021. This common treatment involves irradiating one or more body parts via radiation ports. Often, this treatment involves the use of a custom block or compensator to direct radiation more precisely. These customized components are charged under the radiation treatment aid(s) code.

Providers charged more than $41 million for radiation treatment management (5 treatments) in 2021. Falling just behind at $36 million in total charges is the intensity-modulated radiation therapy (IMRT) dose planning procedure, in which a physician uses 3-D computed tomography (CT) or magnetic resonance imaging (MRI) to calculate precise radiation doses while minimizing damage to normal tissue surrounding a tumor. This procedure is the first of two IMRT treatment phases, the second being treatment delivery.

Stereotactic body radiation therapy (SBRT) is similar to IMRT but provides higher doses of radiation per treatment, usually across fewer treatment sessions. SBRT delivery was the radiation oncology procedure with the sixth-highest total charges in 2021. The reduced treatment duration of SBRT is associated with lower costs overall compared to IMRT, but also with higher genitourinary toxicity.

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