Outpatient Cardiology Procedures for EviCore Arrangement (for Oxford Only)
Policy governing prior authorization, accreditation, and reimbursement requirements for outpatient cardiology procedures managed by EviCore for Oxford (UnitedHealthcare). Affects participating cardiology and radiology providers requesting authorization for advanced outpatient cardiac imaging and catheterization.
Replaced references to 'eviCore healthcare' with 'EviCore' and clarified EviCore by Evernorth as the vendor performing initial reviews that may include site of service review.
Revised list of modalities and CPT codes that require prior authorization through EviCore; removed CPT codes 93306, 93307, and 93308 from the prior-authorization list.
Clarified that Oxford commercial members with out-of-network benefits also need prior authorization for outpatient cardiology studies when using an out-of-network provider.
Updated Description of Services to list specific radiology procedures that may require prior authorization through EviCore (e.g., cardiac CT, cardiac MRI, FFR-CT, nuclear stress testing, cardiac PET, outpatient catheterization, outpatient stress echocardiogram).
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.