77301 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
77301, Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.
- Code
- 77301
- Description
- Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
- Source
- New Hampshire Precertification List, Pg 150 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization