77439 prior authorization | Blue Cross and Blue Shield of Montana

77439, Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per course of treatment (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: 77439
Description: Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per course of treatment (List separately in addition to code for primary procedure)
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 89 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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