0395T prior authorization | Blue Cross and Blue Shield of Montana

0395T, High Dose Rate Electronic Brachytherapy Interstitial Or Intracavitary Treatment Per Fraction Includes Basic Dosimetry When Performed, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 0395T
Description: High Dose Rate Electronic Brachytherapy Interstitial Or Intracavitary Treatment Per Fraction Includes Basic Dosimetry When Performed
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 213 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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