77772 prior authorization | Premera Blue Cross of Washington

77772, Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels, is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.

Code: 77772
Description: Remote afterloading high dose rate radionuclide interstitial or intracavitary brachytherapy, includes basic dosimetry, when performed; over 12 channels
Source: Clinical Review by Code List PBCWA, Pg 428 Original policy

Premera Blue Cross of Washington prior authorization

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