Anthem Blue Cross and Blue Shield Virginia prior authorization 77772

Anthem Blue Cross and Blue Shield Virginia prior authorization for 77772: Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels

Code: 77772
Description: Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 30 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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