Musculoskeletal: Therapies
Clinical Guidelines

Musculoskeletal: Therapies

EviCore.com recently upgraded and some of your bookmarked Clinical Guidelines might have changed. Please ensure you are navigating to our most recent EviCore Clinical Guidelines.
 

Please note:

Adobe PDF Reader is required to view clinical guideline documents.

There may be instances in which your health plan policies take precedence over the EviCore by Evernorth clinical guidelines. If you have any questions, please reach out to your health plan.

If you would like to view all EviCore core guidelines, please type in "EviCore by Evernorth" as your health plan.

Follow the below steps to access the clinical guidelines:

  1. Enter your Health Plan name into the search field and click on the magnifying glass.
  2. To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
  3. Identify the guideline service type from your letter and then search for that guideline title by scrolling down on the page or entering the guideline title into the guideline name search field.
  4. Open the guideline, and scroll to the table of contents and select the appropriate guideline section. The guideline section can be listed either as a description (1) or an exact guideline section (2).
  5. Click on the desired section.

Example:

The reason for denial states in your letter states: This request does not meet medical necessity because: Based on EviCore Guidelines (Musculoskeletal, Massage Therapy, Upper Leg Pain, the findings we received do not support the request for Massage Therapy.

Enter your Health Plan name into the search field and click on the magnifying glass, then click on the corresponding guideline to open the guidelines for the service type (example: Massage Therapy Guidelines).

Once the guideline opens, scroll down to the table of contents page and select the appropriate guideline section noted in the denial reason (example: Upper Leg Pain).

If a specific guideline section is cited, click on the corresponding section (example: PTOT-2.1: Lymphedema).

If you require a copy of the guidelines that were used to make a determination on a specific request of treatment or services, please email the case number and request to: reqcriteria@EviCore.com.

To request any additional assistance in accessing the guidelines, provide feedback or clinical evidence related to the evidence-based guidelines, please click here.

Physical Therapy & Occupational Therapy

Massage

Physical Therapy & Occupational Therapy

Massage

Physical Therapy & Occupational Therapy

Massage