Premera Blue Cross of Washington prior authorization 77371

Premera Blue Cross of Washington prior authorization for 77371: Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cerebral lesion(s) consisting of 1 session; multisource Cobalt 60 based or more lesions, including image guidance, entire course not to exceed 5 fractions

Code: 77371
Description: Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cerebral lesion(s) consisting of 1 session; multisource Cobalt 60 based or more lesions, including image guidance, entire course not to exceed 5 fractions
Source: Clinical Review by Code List PBCWA, Pg 421 Original policy

Premera Blue Cross of Washington prior authorization

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