77301 prior authorization | Anthem Blue Cross Blue Shield of Georgia

77301, Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications, is on the Anthem Blue Cross Blue Shield of Georgia prior authorization list. Not a coverage or referral decision.

Code: 77301
Description: Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications
Source: Standard Local Prior Authorization Code List, Pg 36 Original policy

Anthem Blue Cross Blue Shield of Georgia prior authorization

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