Updated Radiation Therapy Clinical Guidelines

June 29, 2021

eviCore healthcare (eviCore) will use updated Radiation Therapy Clinical Guidelines effective August 1, 2021. The Guidelines are used to determine medical necessity for certain radiation therapy services.

eviCore is an independent company that oversees utilization management activities for certain radiation therapy services for our commercial and Medicare Advantage members.

Notification of this change was posted on eviCore's website on April 19, 2021. Both current and future guidelines can be found on eviCore's Radiation Oncology resource page.

The Independence Radiation Therapy Services policies will be updated effective August 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 Notifications on our Medical and Claim Payment Policy Portal:

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