Premera Blue Cross of Washington prior authorization 77439

Premera Blue Cross of Washington prior authorization for 77439: Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous utmors, per course of treatment (list separately in additiona to code for primary procedure) These criteria do not imply or guarantee approval.

Code: 77439
Description: Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous utmors, per course of treatment (list separately in additiona to code for primary procedure) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 424 Original policy

Premera Blue Cross of Washington prior authorization

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