77767 prior authorization | Blue Cross and Blue Shield of Montana

77767, Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Up To 2.0 Cm Or 1 Channel, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 77767
Description: Remote Afterloading High Dose Rate Radionuclide Skin Surface Brachytherapy Includes Basic Dosimetry When Performed; Lesion Diameter Up To 2.0 Cm Or 1 Channel
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 90 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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