Hub-
Clinical Guidelines

Musculoskeletal: Advanced Procedures

Instructions for accessing the guidelines:
1.     Search by health plan name to view clinical guidelines. If you would like to view all eviCore core guidelines, please type in "eviCore healthcare" as your health plan.
2.     Locate the reason for denial section found in your letter. Identify the guideline title and then search by the guideline title.
Example for Spine Surgery Guidelines: Based on eviCore Spine Surgery Guidelines, CMM 608: Lumbar Decompression (surgery to your low back), we cannot approve this request.
3.     Scroll down to the table of contents page and select the appropriate guideline section provided in the reason for denial.
Example for CMM 608: Lumbar Decompression: Based on eviCore Spine Surgery Guidelines, CMM 608: Lumbar Decompression (surgery to your low back), we cannot approve this request.
4.     Click on the specific guideline section, if cited (e.g., CMM 608.3).