eviCore Radiation Oncology Clinical Guidelines

eviCore’s Radiation Oncology guideline designates specific medically necessary uses — e.g., intravascular brachytherapy for in‑stent restenosis, hyperthermia with EBRT for certain superficial/recurrent tumors (superficial melanoma, chest‑wall breast recurrence, recurrent cervical nodes), IGRT when IMRT is approved or in defined 3DCRT situations, neutron beam for select salivary gland cancers, and proton beam therapy only for narrowly defined indications (skull‑base chordoma/chondrosarcoma, uveal melanoma, select unresectable HCC, Stage IIA seminoma, CSI, pediatric malignancies) — while many other PBT, hyperthermia, IGRT, neutron and other uses are considered experimental, investigational, or not medically necessary. Key requirements include documentation of IMRT approval when requesting IGRT, imaging verification for most brachytherapy, hyperthermia limited to ≤10 twice‑weekly treatments for ≤4 cm non‑metastatic recurrences without concurrent systemic therapy, and stringent documentation (preferably multidisciplinary tumor board minutes or specific alternative evidence) to justify PBT for HCC and other restricted indications.