77373 prior authorization | Premera Blue Cross of Washington

77373, Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 77373
Description: Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions
Source: Clinical Review by Code List PBCWA, Pg 421 Original policy

Premera Blue Cross of Washington prior authorization

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