77387 prior authorization | Premera Blue Cross of Washington

77387, Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed 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: 77387
Description: Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed These criteria do not imply or guarantee approval.
Source: Clinical Review by Code List PBCWA, Pg 421 Original policy

Premera Blue Cross of Washington prior authorization

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