63621 prior authorization | Blue Cross and Blue Shield of Montana

63621, Stereotactic Radiosurgery (Particle Beam Gamma Ray Or Linear Accelerator); Each Additional Spinal Lesion (List Separately In Addition To Code For Primary Procedure), is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 63621
Description: Stereotactic Radiosurgery (Particle Beam Gamma Ray Or Linear Accelerator); Each Additional Spinal Lesion (List Separately In Addition To Code For Primary Procedure)
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 64 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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