77772 prior authorization | Anthem Blue Cross Blue Shield of California

77772, Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels [when specified as coronary intravascular brachytherapy], is on the Anthem Blue Cross Blue Shield of California PPO 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 [when specified as coronary intravascular brachytherapy]
Source: California PPO Prior Authorization List, Pg 122 Original policy

Anthem Blue Cross Blue Shield of California prior authorization

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