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Precertification changes for non-emergent outpatient radiation therapy services

December 30, 2015

As previously communicated, providers are required to obtain precertification through CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent company, for non-emergent outpatient radiation therapy services for all commercial and Medicare Advantage HMO, POS, and PPO members.

Effective January 1, 2016, the list of radiation therapy procedure codes that require precertification has been updated. The following medical policies include an updated list of procedure codes that require precertification as well as a link to the criteria that eviCore will use to determine medical necessity for radiation therapy services:

  • Commercial: #09.00.56b: Radiation Therapy Services;
  • Medicare Advantage: #MA09.020b: Radiation Therapy Services.

To view these policies, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select the Commercial or Medicare Advantage tab from the top of the page, depending on the version of the policy you?d like to view. Type the policy name or number in the Search field.

Requesting precertification

You can initiate precertification for non-emergent outpatient radiation therapy in one of the following ways:

  • NaviNet® web portal. Select eviCore/CareCore from the Authorizations option in the Independence Workflows menu.
  • Telephone. Call eviCore directly at 1-866-686-2649.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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