G0340 prior authorization | Blue Cross and Blue Shield of Montana

G0340, Image-Guided Robotic Linear Accelerator- Based Stereotactic Radiosurgery Delivery Including Collimator Changes And Custom Plugging Fractionated Treatment All Lesions Per Session Second Through Fifth Sessions Maximum Five Sessions Per Course Of Treatment, is on the Blue Cross and Blue Shield of Montana commercial prior authorization list. Not a coverage or referral decision.

Code: G0340
Description: Image-Guided Robotic Linear Accelerator- Based Stereotactic Radiosurgery Delivery Including Collimator Changes And Custom Plugging Fractionated Treatment All Lesions Per Session Second Through Fifth Sessions Maximum Five Sessions Per Course Of Treatment
Source: 2026 Commercial Medical Surgical Prior Authorization Code List, Pg 264 Original policy

Blue Cross and Blue Shield of Montana prior authorization

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