77316 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

77316, Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s), is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 77316
Description: Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s)
Source: New Hampshire Precertification List, Pg 150 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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