eviCore healthcare (eviCore) will use updated Radiation Therapy Clinical Guidelines effective October 1, 2021. The Guidelines are used to determine medical necessity for certain radiation therapy services.
eviCore oversees utilization management activities for certain radiation therapy services for our commercial members.
Both current and future guidelines can be found on eviCore's Radiation Oncology resource page. eviCore published notification of these changes on their website on Friday, July 02, 2021.
AmeriHealth medical policy #09.00.56m: Radiation Therapy Services will be updated effective October 1, 2021. The update will include a link to eviCore's Radiation Therapy Clinical Guidelines and a list of procedure codes. The changes were posted as a Notification on our Medical and Claim Payment Policy Portal.