eviCore Radiation Oncology Clinical Guidelines

The eviCore guideline approves narrowly defined uses of specialized radiation techniques — e.g., coronary intravascular brachytherapy for in‑stent restenosis, hyperthermia only as an adjunct to RT for superficial recurrent melanoma/chest‑wall breast recurrence and select nodal recurrences (depth ≤4 cm, ≤10 treatments), IGRT when paired with IMRT or in specified 3DCRT situations, neutron beam for select salivary gland cancers, and Proton Beam Therapy for Group‑1 indications (skull‑base chordoma/chondrosarcoma, uveal melanoma, select unresectable HCC, Stage IIA seminoma, CSI, pediatric malignancies); many other PBT uses and numerous brachytherapy/neutron/hyperthermia applications are deemed experimental, investigational, or not medically necessary. Key requirements include stringent documentation (multidisciplinary tumor‑board minutes or a detailed six‑point justification for HCC PBT), limits on hyperthermia frequency (≤10 treatments twice weekly at 72‑hour intervals), imaging verification for brachytherapy, and specific IGRT billing/technique constraints and Radium‑223 eligibility criteria.