Blue Cross and Blue Shield of Montana prior authorization 77768

Blue Cross and Blue Shield of Montana prior authorization for 77768: Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Over 2.0 Cm And 2 Or More Channels Or Multiple Lesions

Code: 77768
Description: Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Over 2.0 Cm And 2 Or More Channels Or Multiple Lesions
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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