77317 prior authorization | Premera Blue Cross of Washington

77317, Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s), is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 77317
Description: Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s)
Source: Clinical Review by Code List PBCWA, Pg 420 Original policy

Premera Blue Cross of Washington prior authorization

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