Clinical Information to Determine Medical Necessity

eviCore's Clinical Decision Support tool covers imaging/testing judged medically necessary for common symptoms per its evidence‑based Clinical Review Criteria but excludes atypical presentations, which require physician review and may be denied. Approval requires submission of legible, sufficiently detailed medical records (recent history and physical, labs, imaging/pathology/procedure reports and other relevant provider documentation); lack of adequate or readable documentation is a basis for non‑approval.

"This tool addresses common symptoms and symptom complexes."

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