77772 prior authorization | Anthem Blue Cross and Blue Shield New Hampshire

77772, Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels, is on the Anthem Blue Cross and Blue Shield New Hampshire prior authorization list. Not a coverage or referral decision.

Code: 77772
Description: Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels
Source: New Hampshire Precertification List, Pg 152 Original policy

Anthem Blue Cross and Blue Shield New Hampshire prior authorization

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