77316 prior authorization | Premera Blue Cross of Washington

77316, Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 77316
Description: Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 419 Original policy

Premera Blue Cross of Washington prior authorization

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