77771 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire
77771, Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.
- Code
- 77771
- Description
- Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; 2-12 channels
- Source
- New Hampshire Precertification List, Pg 152 Original policy
Anthem Blue Cross and Blue Shield New Hampshire prior authorization