77767 prior authorization | Premera Blue Cross of Washington

77767, Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 77767
Description: Remote afterloading high dose rate radionuclide skin surface brachytherapy, includes basic dosimetry, when performed; lesion diameter up to 2.0 cm or 1 channel
Source: Clinical Review by Code List PBCWA, Pg 427 Original policy

Premera Blue Cross of Washington prior authorization

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