eviCore Radiation Oncology Clinical Guidelines

Covers a limited set of radiation therapies: single‑treatment coronary artery brachytherapy for in‑stent restenosis, hyperthermia only with concurrent EBRT for select superficial/recurrent lesions, IGRT when paired with approved IMRT or specified 3DCRT indications, proton beam therapy for a defined Group‑1 list (eg, skull‑base chordoma/chondrosarcoma, uveal melanoma when preferred, select unresectable HCC, stage IIA seminoma, CSI, and pediatric malignancies), and multiple site‑specific 3DCRT/IMRT indications (eg, adjuvant ACC, definitive anal cancer, bladder‑preserving RT), while excluding RT for non‑muscle invasive bladder cancer and deeming many PBT, neutron, and other uses experimental/unproven. Key requirements include detailed documentation (recent H&P within 60 days, staging, imaging, pathology, radiation prescription/plan, and tumor‑board minutes or specified alternatives for HCC), adherence to specified fractionation and modality limits (eg, hyperthermia ≤10 sessions twice weekly, single coronary brachytherapy, fraction caps for ACC/anal/bladder), and IGRT billing/operational restrictions (only one IGRT method daily; certain IGRT codes not billed separately).