eviCore Radiation Oncology Clinical Guidelines

eviCore approves specific, site‑ and modality‑limited radiation treatments (e.g., coronary artery brachytherapy for in‑stent restenosis, hyperthermia with RT for superficially recurrent melanoma/chest‑wall breast recurrence/recurrent cervical nodes, IGRT with IMRT and enumerated 3DCRT uses, selected Group‑1 proton indications and pediatric PBT) and explicitly considers neutron therapy, many other proton indications, deep/regional/alternative hyperthermia, and other listed uses experimental, investigational, or not medically necessary. Prior authorization requires recent (≤60 days) radiation oncology consultation, the radiation prescription/treatment plan, imaging and supporting provider reports, adherence to specified modality/fraction limits (eg, adjuvant ACC ≤30 fractions, anal cancer 45–59.4 Gy in 25–33 fractions, hyperthermia ≤10 sessions), proton use often limited to clinical trials/registries or needing dosimetric justification for thoraco‑abdominal sites, and CMS Medicare coverage rules supersede these guidelines.