Evicore Prior Authorization Lookup
Latest Evicore prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-11-05Cerebrovascular Intervention (Endovascular Embolization and Stents)This policy governs medical necessity and prior-authorization guidance for cerebrovascular endovascular procedures (embolization, angioplasty, stents, flow diverters) for members covered under Cigna plans administered with EviCore review. It affects providers requesting authorization for cerebrovascular endovascular interventions.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-05Peripheral Vascular Intervention (PVI) — carotid and arterial revascularization guidanceCoverage policy governing prior-authorization, documentation, and medical necessity determinations for peripheral vascular interventions (including carotid and vertebral revascularization) for Cigna-administered plans; applies to providers requesting authorization for vascular/endovascular procedures.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-11-05Radiation oncology coverage and treatment delivery guidelinesDefines prior authorization, documentation, and medical necessity requirements for radiation oncology treatments (including radiopharmaceuticals and motion management) for Cigna-administered health benefit plans; intended for providers requesting authorization through eviCore.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Epidural Steroid InjectionsCoverage policy for epidural steroid injections (ESIs) and selective nerve root blocks (SNRBs) for specified indications; applies to health benefit plans administered by Cigna and used by eviCore for medical necessity and prior-authorization determinations.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)Defines medical necessity, urgent/emergent indications, credentialing, and coverage criteria for initial and repeat lumbar microdiscectomy and excision of extradural lesions for Cigna-administered plans; applies to providers requesting prior authorization and medical directors making coverage determinations.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Lumbar Total Disc ArthroplastyDefines medical necessity, non-indications, coding, and prior authorization guidance for lumbar total disc arthroplasty for providers and medical directors for Cigna-administered plans.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Preface to Spine Surgery GuidelinesGoverns prior authorization, documentation, and urgency definitions for spine surgery requests for health benefit plans administered by Cigna and used by eviCore medical reviewers and providers submitting authorization requests.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Preface to the Comprehensive Musculoskeletal Management (CMM) GuidelinesPreface and administrative instructions for applying the Cigna/EviCore Comprehensive Musculoskeletal Management (CMM) Guidelines to prior authorization and coverage determinations for musculoskeletal services; intended for providers and medical reviewers administering Cigna health benefit plans.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Sacroiliac Joint Fusion and StabilizationCriteria and coverage guidance for minimally invasive and open sacroiliac (SI) joint fusion and stabilization procedures for plans administered by Cigna and reviewed by eviCore; applies to providers seeking medical necessity determinations and prior authorization.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-04Thoracic Decompression/DiscectomyClinical coverage criteria and prior authorization guidance for initial, repeat, and corpectomy thoracic decompression/discectomy procedures for members covered under Cigna plans administered by eviCore.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Oncology Medications Policy — Coverage and Prior Authorization for Primary and Supportive Cancer TherapiesDefines prior authorization, coverage, and clinical governance for FDA‑approved oncology medications used for direct cancer treatment and specified supportive care therapies under Cigna plans administered by eviCore.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Peripheral Vascular Intervention (PVI) Coverage PolicyCoverage policy for peripheral vascular interventions (arterial and venous), including carotid and vertebral revascularization, applicable to Cigna-administered health plans and used by medical directors and other clinicians to determine medical necessity and prior authorization requirements.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-01Cerebrovascular Endovascular Embolization and StentsClinical coverage policy governing prior-authorization, documentation, and medical necessity criteria for endovascular cerebrovascular procedures (embolization, angioplasty, stent placement, flow diverters) for members under Cigna benefit plans administered by eviCore. Applies to providers requesting authorization for cerebrovascular endovascular interventions.All evicore updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-02-27Biology-Guided Radiation Therapy (BgRT) — Coding and Billing GuidanceThis coding manual provides billing, coding, and administrative guidance for radiation oncology services used by eviCore when administering Cigna health benefit plans; it is intended to guide coding and prior authorization processes but does not itself guarantee coverage.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-25Epidural Steroid Injections and Selective Nerve Root BlocksCoverage criteria and prior authorization guidance for diagnostic selective nerve root blocks (SNRBs) and therapeutic epidural steroid injections (interlaminar, transforaminal, caudal) for musculoskeletal spine indications under Cigna-administered plans.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-25Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/Laminoplasty)Cigna coverage policy governing medical necessity and prior authorization considerations for initial and repeat posterior cervical decompression procedures for members under Cigna-administered plans.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-25Preface to Spine Surgery Guidelines (Prior Authorization Requirements, Urgent/Emergent Requests, Definitions)This document governs prior authorization requirements, urgent/emergent request handling, and definitions used for Cigna-administered spine surgery coverage determinations and applies to providers requesting coverage for spine surgical procedures.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-25Sacroiliac Joint Fusion and StabilizationCoverage policy governing medical necessity, indications, and non-indications for minimally invasive and open sacroiliac (SI) joint fusion and stabilization for members covered under Cigna benefit plans administered by eviCore. Affects providers seeking coverage or prior authorization for SI joint fusion procedures.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-03Pediatric Neck Imaging Guidelines — Clinical Coverage and Prior Authorization GuidanceClinical coverage and appropriate-use guidance for imaging of the pediatric neck (≤18 years) including modality-specific recommendations and associated CPT procedure codes; applies to health benefit plans administered by Cigna and used by eviCore for determination of medical necessity.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-03Pediatric Peripheral Vascular Disease (PVD) Imaging GuidelinesImaging coverage guidelines for evaluation of pediatric peripheral vascular disease (individuals ≤18 years) governing advanced imaging modality selection, appropriateness, and prior authorization requirements for services managed by eviCore for Cigna.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2026-02-03Pediatric and Special Populations Spine Imaging GuidelinesGuidelines governing advanced and basic imaging of the pediatric spine and special populations for Cigna-administered health benefit plans; affects ordering providers, radiology providers, and medical directors involved in imaging prior authorization and coverage determinations.All evicore updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-01-01Rocky Mountain Health Plans: Radiology CPT Code ListA payer-specific list mapping radiology CPT codes to coverage/prior authorization (PA) requirements for Rocky Mountain Health Plans members; indicates Medicare exclusion and PA Medical Necessity Review for Medicaid and Commercial lines for listed codes.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2025-12-18Preface to the Comprehensive Musculoskeletal Management (CMM) GuidelinesApplies to Cigna-administered health benefit plans and describes the use and interpretation of the Comprehensive Musculoskeletal Management (CMM) Guidelines for musculoskeletal procedures and services, including documentation and prior authorization expectations for providers.All evicore updates
- Prior AuthReimbursement/Payment PolicyEff. 2025-01-01Substitution Rules 2025 — CPT/HCPCS code-to-code mappings for CT and MR imagingThis document lists code-to-code substitution mappings and related claim handling notes for various CT and MR imaging CPT codes used by eviCore; it affects billing/coding and precertification/claim submission processes for providers submitting radiology imaging claims.All evicore updates
- Prior AuthClinical/Medical PolicyEff. 2021-09-01Site of Care Review for High-tech Radiology (MRI/CT)Defines eviCore's expansion of prior authorization to include medical necessity review of the site of care for CT and MRI for Cigna commercial (non‑Medicare) and self-funded customers, guiding providers on submission and approval considerations.All evicore updates
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Tool Description
Search Evicoreprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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