Blue Cross and Blue Shield of Montana prior authorization G0563

Blue Cross and Blue Shield of Montana prior authorization for G0563: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real- time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions

Code: G0563
Description: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance and real- time positron emissions-based delivery adjustments to 1 or more lesions, entire course not to exceed 5 fractions
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 266 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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