Musculoskeletal: Advanced Procedures
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Follow the below steps to access the clinical guidelines.
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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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Joint Surgery & Interventional Pain
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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
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CMM-600: Preface to the Spine Surgery Guidelines
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CMM-601: Anterior Cervical Discectomy and Fusion
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CMM-602: Cervical Total Disc Arthroplasty
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CMM-603: Electrical and Low Frequency Ultrasound Bone Growth Stimulation (Spine) Guidelines
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CMM-604: Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/Laminoplasty) with or without Fusion
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CMM-605: Cervical Microdiscectomy
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CMM-607: Primary Vertebral Augmentation Percutaneous Vertebroplasty/Kyphoplasty) and Sacroplasty
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CMM-608: Lumbar Decompression
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CMM-609: Lumbar Fusion (Arthrodesis)
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CMM-610: Lumbar Total Disc Arthroplasty Guidelines
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CMM-611: Sacroiliac Joint Fusion or Stabilization Guidelines
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CMM-612: Grafts Guidelines
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CMM-613: Thoracic Decompression and Discectomy
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CMM-614: Thoracic and Thoracolumbar Fusion
Joint Surgery & Interventional Pain
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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 - 10/31/2024
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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 the Spine SurgeryEffective 11/01/2024
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CMM-600: Preface to Spine Surgery GuidelinesEffective 08/01/2024 - 10/31/2024
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CMM-601 Anterior Cervical Discectomy and FusionEffective 11/01/2024
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CMM-601: Anterior Cervical Discectomy and FusionEffective 08/01/2024 - 10/31/2024
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CMM-602 Cervical Total Discectomy ArthroplastyEffective 11/01/2024
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CMM-602: Cervical Total Disc ArthroplastyEffective 08/01/2024 - 10/31/2024
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CMM-603 Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/ Laminoplasty)Effective 11/01/2024
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CMM-603: Posterior Cervical DecompressionEffective 08/01/2024 - 10/31/2024
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CMM-604 Posterior Cervical FusionEffective 11/01/2024
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CMM-604: Posterior Cervical FusionEffective 08/01/2024 - 10/31/2024
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CMM-605 Cervical MicrodiscectomyEffective 11/01/2024
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CMM-605: Cervical MicrodiscectomyEffective 08/01/2024 - 10/31/2024
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CMM-606 Lumbar MicrodiscectomyEffective 11/01/2024
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CMM-606: Lumbar MicrodiscectomyEffective 08/01/2024 - 10/31/2024
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CMM-607 Primal Vertebral Augmentation (Percutaneous Vertebroplasty-Kyphoplasty) and SacroplastyEffective 11/01/2024
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CMM-607: Primal Vertebral Augmentation Percutaneous Vertebroplasty-Kyphoplasty and SacroplastyEffective 08/01/2024 - 10/31/2024
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CMM-608 Lumbar DecompressionEffective 11/01/2024
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CMM-608: Lumbar DecompressionEffective 08/01/2024 - 10/31/2024
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CMM-609 Lumbar Fusion (Arthrodesis)Effective 11/01/2024
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CMM-609: Lumbar FusionEffective 08/01/2024 - 10/31/2024
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CMM-610 Lumbar Total Discectomy ArthroplastyEffective 11/01/2024
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CMM-610: Lumbar Total Disc ArthroplastyEffective 08/01/2024 - 10/31/2024
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CMM-611 Sacroiliac Joint Fusion or StabilizationEffective 11/01/2024
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CMM-611: Sacroiliac Joint Fusion or StabilizationEffective 08/01/2024 - 10/31/2024
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CMM-612 GraftsEffective 11/01/2024
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CMM-612: GraftsEffective 08/01/2024 - 10/31/2024
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CMM-613 Thoracic Decompression and DiscectomyEffective 11/01/2024
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CMM-613: Thoracic Decompression and DiscectomyEffective 08/01/2024 - 10/31/2024
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CMM-614 Thoracic and Thoracolumbar Fusion (Arthrodesis)Effective 11/01/2024
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CMM-614: Thoracic and Thoracolumbar FusionEffective 08/01/2024 - 10/31/2024
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CMM-615 Electrical and Low Frequency US Bone Growth Stimulation SpineEffective 11/01/2024
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CMM-615: Electrical and Low Frequency US Bone Growth Stimulation SpineEffective 08/01/2024 - 10/31/2024
Joint Surgery & Interventional Pain
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CMM-200: Epidural Steroid InjectionsEffective 09/01/2022 - 05/30/2023
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 09/01/2022 - 05/30/2023
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CMM-202: Trigger Point InjectionsEffective 09/01/2022 - 05/30/2023
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CMM-203: Sacroiliac Joint ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-204: ProlotherapyEffective 09/01/2022 - 05/30/2023
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CMM-207: Epidural AdhesiolysisEffective 09/01/2022 - 05/30/2023
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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-209: Regional Sympathetic BlocksEffective 09/01/2022 - 05/30/2023
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 09/01/2022 - 05/30/2023
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CMM-211: Spinal Cord and Dorsal Root Ganglion StimulationEffective 09/01/2022 - 05/30/2023
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CMM-308: Intradiscal ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-310: Manipulation Under AnesthesiaEffective 09/01/2022 - 05/30/2023
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CMM-311: Knee Replacement/ArthroplastyEffective 09/01/2022 - 05/30/2023
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-313: Hip Replacement/ ArthroplastyEffective 09/01/2022 - 05/30/2023
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 09/01/2022 - 05/30/2023
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CMM-400: Anesthesia Services for Interventional Pain ProceduresEffective 09/01/2022 - 05/30/2023
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CMM-401: DiscographyEffective 09/01/2022 - 05/30/2023
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CMM-402: Greater Occipital Nerve BlockEffective 09/01/2022 - 05/30/2023
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CMM-403: Neurolytic Agent Creation of LesionEffective 09/01/2022 - 05/30/2023
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CMM-405: Spinal FluoroscopyEffective 09/01/2022 - 05/30/2023
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CMM-406: Arthroscopy AnkleEffective 09/01/2022 - 05/30/2023
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CMM-407: Arthroscopy Subtalar JointEffective 09/01/2022 - 05/30/2023
Spine Surgery
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CMM-600: Preface to the Spine Surgery GuidelinesEffective 09/01/2022 - 05/30/2023
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CMM-601: Anterior Cervical Discectomy and FusionEffective 09/01/2022 - 05/30/2023
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CMM-602: Cervical Total Disc ArthroplastyEffective 09/01/2022 - 05/30/2023
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CMM-603: Electrical and Low Frequency Ultrasound Bone Growth Stimulation (Spine) GuidelinesEffective 09/01/2022 - 05/30/2023
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CMM-604: Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/Laminoplasty) with or without FusionEffective 09/01/2022 - 05/30/2023
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CMM-605: Cervical MicrodiscectomyEffective 09/01/2022 - 05/30/2023
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CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)Effective 05/31/2023 - 07/01/2024
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CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)Effective 09/01/2022 - 05/30/2023
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CMM-607: Primary Vertebral Augmentation Percutaneous Vertebroplasty/Kyphoplasty) and SacroplastyEffective 09/01/2022 - 05/30/2023
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CMM-608: Lumbar DecompressionEffective 09/01/2022 - 05/30/2023
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CMM-609: Lumbar Fusion (Arthrodesis)Effective 09/01/2022 - 05/30/2023
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CMM-610: Lumbar Total Disc ArthroplastyEffective 09/01/2022 - 12/31/2022
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CMM-610: Lumbar Total Disc ArthroplastyEffective 01/01/2023 - 05/30/2023
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CMM-611: Sacroiliac Joint Fusion or StabilizationEffective 09/01/2022 - 12/31/2022
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CMM-611: Sacroiliac Joint Fusion or StabilizationEffective 01/01/2023 - 05/30/2023
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CMM-612: GraftsEffective 09/01/2022 - 05/30/2023
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CMM-613: Thoracic Decompression and DiscectomyEffective 09/01/2022 - 05/30/2023
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CMM-614: Thoracic and Thoracolumbar FusionEffective 09/01/2022 - 05/30/2023
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Spine Surgery GuidelinesEffective 08/01/2022 - 08/31/2022