77316 prior authorization | Blue Cross and Blue Shield of Montana

77316, Brachytherapy Isodose Plan; Simple (Calculation[S] Made From 1 To 4 Sources Or Remote Afterloading Brachytherapy 1 Channel) Includes Basic Dosimetry Calculation(S), is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 77316
Description: Brachytherapy Isodose Plan; Simple (Calculation[S] Made From 1 To 4 Sources Or Remote Afterloading Brachytherapy 1 Channel) Includes Basic Dosimetry Calculation(S)
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 86 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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