Clinical Guidelines

Musculoskeletal: Therapies

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 provided guideline title usually associated with the service requested. Example: Massage Therapy could be listed next to Service.

3.     Scroll down to the table of contents page and select the appropriate guideline section provided in the reason for denial. The guideline section can be listed either as a description (1) or as an exact guideline section (2).
Example for Upper Leg Pain: 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 this request for massage therapy.
Example for PTOT-2.1: Lymphedema: Click on the specific guideline section, if cited (e.g., PTOT-2.1: Lymphedema).