Blue Cross and Blue Shield of Montana prior authorization G0340

Blue Cross and Blue Shield of Montana prior authorization for G0340: Image-Guided Robotic Linear Accelerator- Based Stereotactic Radiosurgery Delivery Including Collimator Changes And Custom Plugging Fractionated Treatment All Lesions Per Session Second Through Fifth Sessions Maximum Five Sessions Per Course Of Treatment

Code: G0340
Description: Image-Guided Robotic Linear Accelerator- Based Stereotactic Radiosurgery Delivery Including Collimator Changes And Custom Plugging Fractionated Treatment All Lesions Per Session Second Through Fifth Sessions Maximum Five Sessions Per Course Of Treatment
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 264 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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