Musculoskeletal: Advanced Procedures
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Follow the below steps to access the clinical guidelines.
- Enter your Health Plan name into the search field and click on the magnifying glass.
- To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
- Identify the guideline title and/or number, then search for that guideline by scrolling down on the page. (You may also enter the guideline title into the guideline title search field).
- Open the desired guideline by clicking on it.
- Access the specific guideline section, if cited by scrolling to the table of contents and clicking on the section mentioned in your letter.
Example:
The reason for denial states in your letter states: Based on EviCore Comprehensive Musculoskeletal Management Guideline CMM 312 - Knee Surgery-Arthroscopic and Open Procedures (type of surgery to your knee).
Enter your Health Plan name into the search field and click on the magnifying glass. Locate the guideline by name, then click on the corresponding guideline to open the guideline document (example: CMM-312: knee Surgery- Arthroscopic and Open Procedures).
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Pain & Joint Surgery
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CMM-200: Epidural Steroid Injections
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CMM-201: Facet Joint Injections/Medial Branch Blocks
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CMM-202: Trigger Point Injections
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CMM-203: Sacroiliac Joint Procedures
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CMM-204: Prolotherapy
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CMM-207: Epidural Adhesiolysis
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CMM-208: Ablations/Denervations of Facet Joints and Peripheral Nerves
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CMM-209: Regional Sympathetic Blocks
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CMM-210: Implantable Intrathecal Drug Delivery Systems
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CMM-211: Spinal Cord and Dorsal Root Ganglion Stimulation
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CMM-308: Intradiscal Procedures
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CMM-310: Manipulation Under Anesthesia
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CMM-311: Knee Replacement/Arthroplasty
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CMM-312: Knee Surgery-Arthroscopic and Open Procedures
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CMM-313: Hip Replacement/ Arthroplasty
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CMM-314: Hip Surgery-Arthroscopic and Open Procedures
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CMM-315: Shoulder Surgery-Arthroscopic and Open Procedures
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/Revision/Arthrodesis
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CMM-400: Anesthesia Services for Interventional Pain Procedures
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CMM-401: Discography
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CMM-402: Greater Occipital Nerve Block
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CMM-403: Neurolytic Agent Creation of Lesion
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CMM-405: Spinal Fluoroscopy
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CMM-406: Arthroscopy Ankle
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CMM-407: Arthroscopy Subtalar Joint
Spine Surgery
Pain & Joint Surgery
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CMM-200: Epidural Steroid InjectionsEffective 08/01/2024
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 08/01/2024
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CMM-202: Trigger Point InjectionsEffective 08/01/2024
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CMM-203: Sacroiliac Joint ProceduresEffective 08/01/2024
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CMM-204: ProlotherapyEffective 08/01/2024
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CMM-207: Epidural AdhesiolysisEffective 08/01/2024
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CMM-208: Ablations/Denervations of Facet Joints and Peripheral NervesEffective 08/01/2024
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CMM-209: Regional Sympathetic BlocksEffective 08/01/2024
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 08/01/2024
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CMM-211: Spinal Cord and Dorsal Root Ganglion StimulationEffective 08/01/2024
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CMM-308: Intradiscal ProceduresEffective 08/01/2024
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CMM-310: Manipulation Under AnesthesiaEffective 08/01/2024
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CMM-311: Knee Replacement/ArthroplastyEffective 08/01/2024
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 08/01/2024
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CMM-313: Hip Replacement/ ArthroplastyEffective 08/01/2024
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 08/01/2024
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 08/01/2024
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/Revision/ArthrodesisEffective 08/01/2024
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 08/01/2024
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CMM-401: DiscographyEffective 08/01/2024
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CMM-402: Greater Occipital Nerve BlockEffective 08/01/2024
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CMM-403: Neurolytic Agent Creation of LesionEffective 08/01/2024
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CMM-405: Spinal FluoroscopyEffective 08/01/2024
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CMM-406: Arthroscopy AnkleEffective 08/01/2024
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CMM-407: Arthroscopy Subtalar JointEffective 08/01/2024
Spine Surgery
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CMM-600: Preface to Spine Surgery GuidelinesEffective 08/01/2024
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CMM-601: Anterior Cervical Discectomy and FusionEffective 08/01/2024
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CMM-602: Cervical Total Disc ArthroplastyEffective 08/01/2024
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CMM-603: Posterior Cervical DecompressionEffective 08/01/2024
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CMM-604: Posterior Cervical FusionEffective 08/01/2024
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CMM-605: Cervical MicrodiscectomyEffective 08/01/2024
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CMM-606: Lumbar MicrodiscectomyEffective 08/01/2024
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CMM-607: Primal Vertebral Augmentation Percutaneous Vertebroplasty-Kyphoplasty and SacroplastyEffective 08/01/2024
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CMM-608: Lumbar DecompressionEffective 08/01/2024
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CMM-609: Lumbar FusionEffective 08/01/2024
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CMM-610: Lumbar Total Disc ArthroplastyEffective 08/01/2024
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CMM-611: Sacroiliac Joint Fusion or StabilizationEffective 08/01/2024
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CMM-612: GraftsEffective 08/01/2024
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CMM-615: Electrical and Low Frequency US Bone Growth Stimulation SpineEffective 08/01/2024
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Clinical Information to Establish Medical NecessityEffective 01/01/2021 - 07/14/2021
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Clinical Information to Establish Medical NecessityEffective 07/15/2021 - 04/02/2023
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Preface to the Comprehensive Musculoskeletal GuidelinesEffective 11/01/2022 - 10/31/2023
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Preface to the Comprehensive Musculoskeletal GuidelinesEffective 11/11/2021 - 10/31/2022
Pain & Joint Surgery
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Addendum to eviCore GuidelinesEffective 02/04/2021 - 06/30/2021
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Addendum to eviCore GuidelinesEffective 01/01/2021 - 02/03/2021
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Addendum to the eviCore Musculoskeletal Advanced Procedures GuidelinesEffective 02/04/2021 - 06/30/2021
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Addendum to the eviCore Musculoskeletal Advanced Procedures GuidelinesEffective 01/01/2021 - 02/03/2021
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CMM-200: Epidural Steroid InjectionsEffective 08/01/2022 - 05/30/2023
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CMM-200: Epidural Steroid InjectionsEffective 07/01/2021 - 07/31/2022
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CMM-200: Epidural Steroid Injections (ESI)Effective 02/04/2021 - 06/30/2021
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CMM-200: Epidural Steroid Injections (ESI)Effective 01/01/2021 - 02/03/2021
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 08/01/2022 - 05/30/2023
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 07/01/2021 - 07/31/2022
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 12/14/2020 - 02/03/2021
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 02/04/2021 - 06/30/2021
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 01/01/2021 - 02/03/2021
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CMM-202: Trigger Point InjectionsEffective 02/04/2021 - 06/30/2021
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CMM-202: Trigger Point InjectionsEffective 01/01/2021 - 02/03/2021
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CMM-202: Trigger Point InjectionsEffective 07/01/2021 - 07/31/2022
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CMM-202: Trigger Point InjectionsEffective 08/01/2022 - 05/30/2023
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CMM-203: Sacroiliac Joint ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-203: Sacroiliac Joint ProceduresEffective 08/01/2022 - 05/31/2023
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CMM-203: Sacroiliac Joint ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-203: Sacroiliac Joint ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-204: ProlotherapyEffective 08/01/2022 - 05/30/2023
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CMM-204: ProlotherapyEffective 01/01/2021 - 02/03/2021
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CMM-204: ProlotherapyEffective 07/01/2021 - 07/31/2022
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CMM-204: ProlotherapyEffective 02/04/2021 - 06/30/2021
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CMM-207: Epidural AdhesiolysisEffective 01/01/2021 - 02/03/2021
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CMM-207: Epidural AdhesiolysisEffective 08/01/2022 - 05/30/2023
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CMM-207: Epidural AdhesiolysisEffective 07/01/2021 - 07/31/2022
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CMM-207: Epidural AdhesiolysisEffective 02/04/2021 - 06/30/2021
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CMM-208: Ablations/Denervations of Facet Joints and Peripheral NervesEffective 09/01/2022 - 05/30/2023
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CMM-208: Ablations/Denervations of Facet Joints and Peripheral NervesEffective 08/01/2022 - 08/31/2022
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 07/01/2021 - 07/31/2022
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 02/04/2021 - 06/30/2021
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 01/01/2021 - 02/03/2021
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CMM-209: Regional Sympathetic BlocksEffective 07/01/2021 - 07/31/2022
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CMM-209: Regional Sympathetic BlocksEffective 02/04/2021 - 06/30/2021
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CMM-209: Regional Sympathetic BlocksEffective 08/01/2022 - 05/30/2023
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CMM-209: Regional Sympathetic BlocksEffective 01/01/2021 - 02/03/2021
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 07/01/2021 - 07/31/2022
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 08/01/2022 - 05/30/2023
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 02/04/2021 - 06/30/2021
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 01/01/2021 - 02/03/2021
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CMM-211: Spinal Cord and Dorsal Root Ganglion StimulationEffective 09/01/2022 - 05/30/2023
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CMM-211: Spinal Cord and Dorsal Root Ganglion StimulationEffective 08/01/2022 - 08/31/2022
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CMM-211: Spinal Cord and Dorsal Root Ganglion StimulationEffective 07/01/2021 - 07/31/2022
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CMM-211: Spinal Cord StimulatorsEffective 02/04/2021 - 06/30/2021
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CMM-211: Spinal Cord StimulatorsEffective 01/01/2021 - 02/03/2021
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CMM-308: Intradiscal ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-308: Intradiscal ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-308: Intradiscal ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-308: Intradiscal ProceduresEffective 08/01/2022 - 05/30/2023
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CMM-310: Manipulation Under AnesthesiaEffective 01/01/2021 - 02/03/2021
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CMM-310: Manipulation Under AnesthesiaEffective 02/04/2021 - 06/30/2021
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CMM-310: Manipulation Under AnesthesiaEffective 07/01/2021 - 07/31/2022
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CMM-310: Manipulation Under AnesthesiaEffective 08/01/2022 - 05/30/2023
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CMM-311: Knee Replacement/ArthroplastyEffective 02/04/2021 - 06/30/2021
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CMM-311: Knee Replacement/ArthroplastyEffective 07/01/2021 - 07/31/2022
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CMM-311: Knee Replacement/ArthroplastyEffective 08/01/2022 - 05/30/2023
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CMM-311: Knee Replacement/ArthroplastyEffective 01/01/2021 - 02/03/2021
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 08/01/2022 - 05/30/2023
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-313: Hip Replacement/ ArthroplastyEffective 02/04/2021 - 06/30/2021
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CMM-313: Hip Replacement/ ArthroplastyEffective 07/01/2021 - 07/31/2022
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CMM-313: Hip Replacement/ ArthroplastyEffective 01/01/2021 - 02/03/2021
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CMM-313: Hip Replacement/ ArthroplastyEffective 08/01/2022 - 05/30/2023
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 08/01/2022 - 05/30/2023
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 08/01/2022 - 05/30/2023
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 02/04/2021 - 06/30/2021
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 07/01/2021 - 07/31/2022
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 08/01/2022 - 05/30/2023
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 01/01/2021 - 02/03/2021
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 08/01/2022 - 05/30/2023
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 01/01/2021 - 02/03/2021
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 07/01/2021 - 12/31/2021
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 01/01/2022 - 07/31/2022
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CMM-401: DiscographyEffective 07/01/2021 - 07/31/2022
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CMM-401: DiscographyEffective 08/01/2022 - 05/30/2023
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CMM-402: Greater Occipital Nerve BlockEffective 08/01/2022 - 05/30/2023
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CMM-402: Greater Occipital Nerve BlockEffective 07/01/2021 - 07/31/2022
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CMM-403: Neurolytic Agent Creation of LesionEffective 07/01/2021 - 07/31/2022
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CMM-403: Neurolytic Agent Creation of LesionEffective 08/01/2022 - 05/30/2023
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CMM-404: EpidurographyEffective 07/01/2021 - 12/31/2021
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CMM-405: Spinal FluoroscopyEffective 07/01/2021 - 07/31/2022
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CMM-405: Spinal FluoroscopyEffective 08/01/2022 - 05/30/2023
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CMM-406: Arthroscopy AnkleEffective 08/01/2022 - 05/30/2023
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CMM-406: Arthroscopy AnkleEffective 07/01/2021 - 07/31/2022
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CMM-407: Arthroscopy Subtalar JointEffective 07/01/2021 - 07/31/2022
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CMM-407: Arthroscopy Subtalar JointEffective 08/01/2022 - 05/30/2023