EviCore Radiation Oncology Clinical Guidelines

EviCore's guidelines deem biology‑guided radiation therapy (BgRT) and neutron beam therapy not medically necessary for all indications, allow one‑time coronary artery brachytherapy only as adjunct for in‑stent restenosis when DES or bypass are not options, limit hyperthermia to specified superficial/locoregional recurrences (melanoma chest wall, breast chest wall recurrence, recurrent cervical lymph nodes) with no concurrent systemic therapy for metastatic disease and tumor depth ≤4 cm (max 10 twice‑weekly treatments), consider IGRT medically necessary with IMRT and for a defined list of 3DCRT indications, and restrict proton beam therapy (PBT) to listed Group 1 curative indications (e.g., pediatric tumors, select skull‑base/CNS, ocular, certain sarcomas/hepatobiliary/mediastinal/retroperitoneal tumors and re‑irradiation when photons exceed normal‑tissue constraints) while deeming PBT not medically necessary for many adult cancers (including routine prostate, most lung, breast, GI, pelvic, palliative or metastatic indications). Key requirements include submission of a detailed radiation oncology consult, treatment prescription/plan and imaging, dosimetric comparisons and justification for PBT/re‑irradiation, and—where specified (eg, prostate and certain Group 2 indications)—enrollment in a prospective clinical trial or registry; billing/IGRT use limits (SBRT/SRS bundled, one IGRT method daily) and documentation of motion/immobilization strategies are also required.