Clinical Guidelines

Radiation Oncology

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.     Click on the clinical guideline book
3.     Scroll down to the table of contents page and select the appropriate guideline section from the denial reason.
Example for Bone Metastases: Based on eviCore Radiation Therapy (RT) Guidelines Section: Radiation Therapy for Bone Metastases, we cannot approve this request.

Clinical Guidelines

Coding Guidelines

Requirements for Clinical Appeal