77317 prior authorization | Blue Cross and Blue Shield of Montana

77317, Brachytherapy Isodose Plan; Intermediate (Calculation[S] Made From 5 To 10 Sources Or Remote Afterloading Brachytherapy 2- 12 Channels) 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: 77317
Description: Brachytherapy Isodose Plan; Intermediate (Calculation[S] Made From 5 To 10 Sources Or Remote Afterloading Brachytherapy 2- 12 Channels) 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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