77317 prior authorization | Anthem Blue Cross and Blue Shield Virginia

77317, Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.

Code: 77317
Description: Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(
Source: Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 29 Original policy

Anthem Blue Cross and Blue Shield Virginia prior authorization

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