Musculoskeletal: Advanced Procedures
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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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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-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
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-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)
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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
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Clinical Information to Establish Medical NecessityEffective 07/15/2021 - 04/02/2023
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Clinical Information to Establish Medical NecessityEffective 10/01/2020 - 07/14/2021
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Preface to the Comprehensive Musculoskeletal GuidelinesEffective 11/11/2021 - 10/31/2022
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Preface to the Comprehensive Musculoskeletal GuidelinesEffective 11/01/2022 - 10/31/2023
Pain & Joint Surgery
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CMM-200: Epidural Steroid InjectionsEffective 07/01/2021 - 07/31/2022
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CMM-200: Epidural Steroid InjectionsEffective 08/01/2022 - 05/30/2023
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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 08/01/2019 - 02/13/2020
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CMM-200: Epidural Steroid Injections (ESI)Effective 02/14/2020 - 02/03/2021
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CMM-200: Epidural Steroid Injections (ESI)Effective 08/01/2018 - 03/03/2019
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CMM-200: Epidural Steroid Injections (ESI)Effective 03/04/2019 - 07/31/2019
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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 12/14/2020 - 02/03/2021
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 02/15/2019 - 02/13/2020
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 03/04/2019 - 02/13/2020
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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 02/04/2021 - 06/30/2021
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CMM-201: Facet Joint Injections/Medial Branch BlocksEffective 08/01/2018 - 03/03/2019
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CMM-202: Trigger Point InjectionsEffective 08/01/2022 - 05/30/2023
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CMM-202: Trigger Point InjectionsEffective 08/01/2018 - 03/03/2019
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CMM-202: Trigger Point InjectionsEffective 03/04/2019 - 02/13/2020
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CMM-202: Trigger Point InjectionsEffective 02/14/2020 - 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 02/04/2021 - 06/30/2021
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CMM-203: Sacroiliac Joint InjectionsEffective 08/01/2019 - 02/13/2020
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CMM-203: Sacroiliac Joint InjectionsEffective 03/04/2019 - 07/31/2019
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CMM-203: Sacroiliac Joint InjectionsEffective 08/01/2018 - 03/03/2019
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CMM-203: Sacroiliac Joint ProceduresEffective 08/01/2022 - 05/31/2023
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CMM-203: Sacroiliac Joint ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-203: Sacroiliac Joint ProceduresEffective 02/14/2020 - 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 08/01/2018 - 03/03/2019
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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-204: ProlotherapyEffective 03/04/2019 - 02/13/2020
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CMM-204: ProlotherapyEffective 02/14/2020 - 02/03/2021
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CMM-204: ProlotherapyEffective 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 08/01/2022 - 05/30/2023
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CMM-207: Epidural AdhesiolysisEffective 03/04/2019 - 02/13/2019
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CMM-207: Epidural AdhesiolysisEffective 02/04/2021 - 06/30/2021
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CMM-207: Epidural AdhesiolysisEffective 08/01/2018 - 03/03/2019
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CMM-207: Epidural AdhesiolysisEffective 02/14/2020 - 02/03/2021
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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 08/01/2018 - 03/03/2019
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 03/04/2019 - 07/31/2019
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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 07/01/2021 - 07/31/2022
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 02/14/2020 - 02/03/2021
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CMM-208: Radiofrequency Joint Ablations/DenervationsEffective 08/01/2019 - 02/13/2020
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CMM-209: Regional Sympathetic BlocksEffective 07/01/2021 - 07/31/2022
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CMM-209: Regional Sympathetic BlocksEffective 03/04/2019 - 02/13/2013
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CMM-209: Regional Sympathetic BlocksEffective 02/04/2021 - 06/30/2021
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CMM-209: Regional Sympathetic BlocksEffective 02/14/2020 - 02/03/2021
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CMM-209: Regional Sympathetic BlocksEffective 08/01/2022 - 05/30/2023
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CMM-210: Implantable Intrathecal DrugEffective 08/01/2018 - 03/03/2019
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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 08/01/2019 - 02/13/2020
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 03/04/2019 - 07/31/2019
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CMM-210: Implantable Intrathecal Drug Delivery SystemsEffective 02/14/2020 - 02/03/2021
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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 07/01/2021 - 07/31/2022
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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 and Dorsal Root Ganglion StimulationEffective 08/01/2022 - 08/31/2022
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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 StimulatorsEffective 08/01/2019 - 02/13/2020
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CMM-211: Spinal Cord StimulatorsEffective 02/04/2021 - 06/30/2021
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CMM-211: Spinal Cord StimulatorsEffective 03/04/2019 - 07/31/2019
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CMM-211: Spinal Cord StimulatorsEffective 02/14/2020 - 02/03/2021
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CMM-308: Intradiscal ProceduresEffective 02/14/2020 - 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-308: Thermal Intradiscal ProceduresEffective 08/01/2018 - 03/03/2019
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CMM-308: Thermal Intradiscal ProceduresEffective 08/01/2019 - 02/13/2020
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CMM-308: Thermal Intradiscal ProceduresEffective 03/04/2019 - 07/31/2019
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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-310: Manipulation Under AnesthesiaEffective 02/14/2020 - 02/03/2021
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CMM-310: Manipulation Under AnesthesiaEffective 08/01/2018 - 03/03/2019
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CMM-310: Manipulation Under AnesthesiaEffective 03/04/2019 - 02/13/2020
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CMM-310: Manipulation Under AnesthesiaEffective 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 03/04/2019 - 07/31/2019
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CMM-311: Knee Replacement/ArthroplastyEffective 08/01/2022 - 05/30/2023
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CMM-311: Knee Replacement/ArthroplastyEffective 08/01/2019 - 02/13/2020
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CMM-311: Knee Replacement/ArthroplastyEffective 08/01/2018 - 03/03/2019
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CMM-311: Knee Replacement/ArthroplastyEffective 02/14/2020 - 02/03/2021
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CMM-311: Knee Replacement/ArthroplastyEffective 02/04/2021 - 06/30/2021
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 03/04/2019 - 07/31/2019
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CMM-312: Knee Surgery-Arthroscopic and Open ProceduresEffective 08/01/2018 - 03/03/2019
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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 03/04/2019 - 07/31/2019
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CMM-313: Hip Replacement/ ArthroplastyEffective 08/01/2018 - 03/03/2019
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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 02/04/2021 - 06/30/2021
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 02/14/2020 - 02/03/2021
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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 03/04/2019 - 07/31/2019
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 07/01/2021 - 07/31/2022
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CMM-314: Hip Surgery-Arthroscopic and Open ProceduresEffective 08/01/2018 - 03/03/2019
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CMM-315: Shoulder Surgery- Arthroscopic and Open ProceduresEffective 08/01/2018 - 03/03/2019
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CMM-315: Shoulder Surgery- Arthroscopic and Open ProceduresEffective 03/04/2019 - 02/13/2020
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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 07/01/2021 - 07/31/2022
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CMM-315: Shoulder Surgery-Arthroscopic and Open ProceduresEffective 02/04/2021 - 06/30/2021
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 03/04/2019 - 02/13/2020
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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 02/04/2021 - 06/30/2021
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CMM-318: Shoulder Arthroplasty/Replacement/Resurfacing/ Revision/ArthrodesisEffective 08/01/2018 - 03/03/2019
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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 02/14/2020 - 02/03/2021
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 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 03/01/2023 - 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: Grafts GuidelinesEffective 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 Services GuidelinesEffective 03/04/2019 - 07/31/2019
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Spine Services GuidelinesEffective 08/01/2018 - 03/03/2019
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Spine Surgery GuidelinesEffective 07/01/2021 - 12/31/2021
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Spine Surgery GuidelinesEffective 02/14/2020 - 06/30/2021
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Spine Surgery GuidelinesEffective 01/01/2022 - 07/31/2022
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Spine Surgery GuidelinesEffective 08/01/2022 - 08/31/2022