eviCore Radiation Therapy Clinical Guidelines

eviCore’s Radiation Therapy Clinical Guidelines approve specific, site‑based treatments (e.g., coronary artery brachytherapy only as adjunct to PCI for BMS/SVG in‑stent restenosis; hyperthermia with radiation for select superficial/recurrent tumors ≤4 cm depth and ≤10 twice‑weekly treatments; IGRT when IMRT is approved with site‑specific modality limits; neutron therapy for selected salivary gland cancers; proton therapy only for listed indications—skull‑base chordoma/chondrosarcoma, select uveal melanomas, localized unresectable HCC when preferred, Stage IIA seminoma—and photon/electron/selective brachytherapy for non‑melanoma skin cancer), while many other indications and modalities (e.g., electronic brachytherapy for skin, most PBT uses, PBT+photon, DES brachytherapy, deep/whole‑body hyperthermia, numerous AccuBoost/IORT breast uses) are considered experimental/investigational and excluded. Key requirements include prior medical review for many brachytherapy requests, site‑specific documentation (comparative 3D vs IMRT plans and DVHs for IMRT approval, PET/Deauville, LDH, testosterone or other labs/imaging as applicable), adherence to prescribed dose/fractionation and device/temperature protocols, IGRT imaging/shifts review and RO approval before next treatment, and coding/billing rules (IGRT technical component generally bundled with IMRT and not billed separately).