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
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