Preface to the Radiation Oncology Clinical Guidelines

eviCore covers radiation oncology services only when medical necessity is established via an evidence-based evaluation and adequate clinical documentation, and excludes investigational/experimental treatments lacking supportive evidence, duplicate or very‑similar recent treatments, or requests with insufficient records; CMS and applicable state/federal laws take precedence. Approval requires recent (within 60 days) clinical evaluation with history and physical, disease stage/type, radiation prescription and treatment plan (fractions/doses), imaging, pathology and relevant provider reports, with clinical-trial requests considered only if they meet Health Plan/eviCore criteria.

"Clinical trial requests: "Similar to investigational and experimental studies, clinical trial requests will be considered to determine whether they meet Health Plan coverage and eviCore's evidence-..."