Radiation Oncology
Clinical Guidelines

Radiation Oncology

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Please note:

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There may be instances in which your health plan policies take precedence over the EviCore by Evernorth clinical guidelines. If you have any questions, please reach out to your health plan.

If you would like to view all EviCore core guidelines, please type in "EviCore by Evernorth" as your health plan.

Follow the below steps to access the clinical guidelines.

  1. Enter your Health Plan name into the search field and click on the magnifying glass.
  2. Click on the Clinical Guidelines Link.
  3. To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
  4. Identify the guideline title and then search for that guideline title by scrolling down to the table of contents and clicking on the guideline section mentioned in your letter.


The reason for denial states in your letter states: Based on EviCore Radiation Therapy (RT) Guidelines Section: Radiation Therapy for Bone Metastases, we cannot approve this request.

Enter your Health Plan name into the search field and click on the magnifying glass, open the clinical guidelines document. Scroll to the table of contents and locate the reason for denial mentioned in your letter (example: Bone Metastases).

If you require a copy of the guidelines that were used to make a determination on a specific request of treatment or services, please email the case number and request to: reqcriteria@EviCore.com.

To request any additional assistance in accessing the guidelines, provide feedback or clinical evidence related to the evidence-based guidelines, please click here.

There are no Clinical Guidelines associated with this health plan.

Clinical Guidelines