77373 prior authorization | Blue Cross and Blue Shield of Montana

77373, Stereotactic Body Radiation Therapy Treatment Delivery Per Fraction To 1 Or More Lesions Including Image Guidance Entire Course Not To Exceed 5 Fractions, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 77373
Description: Stereotactic Body Radiation Therapy Treatment Delivery Per Fraction To 1 Or More Lesions Including Image Guidance Entire Course Not To Exceed 5 Fractions
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 87 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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