77772 prior authorization | Blue Cross and Blue Shield of Montana

77772, Remote Afterloading High Dose Rate Radionuclide Interstitial Or Intracavitary Brachytherapy Includes Basic Dosimetry When Performed; Over 12 Channels, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: 77772
Description: Remote Afterloading High Dose Rate Radionuclide Interstitial Or Intracavitary Brachytherapy Includes Basic Dosimetry When Performed; Over 12 Channels
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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