We’re partnering with EviCore on a new authorization program for outpatient radiation oncology procedures. This new program is slated to launch Sept. 15, 2024.
Why work with EviCore?
The science and evidence behind radiation oncology is rapidly evolving, and the field requires sub-specialists to provide care and service to patients. With EviCore’s expertise, we’ll be able to ensure our members get the right care at the right site at the right time.
Their process is aligned with our clinical approach by reviewing requested care and using evidence-based guidelines to make care plan decisions.
How will the program work?
You'll initiate the authorization request process in prism, as you do now. When an outpatient radiation oncology procedure requires authorization through EviCore, prism’s Request an Authorization page will automatically redirect you to EviCore’s online authorization portal.
What radiation oncology procedures will require authorization through EviCore?
Beginning this fall, the following services will require authorization through EviCore when done in an outpatient setting, for all lines of business:
| Procedure type | Codes requiring auth (new auth requirements in bold) |
| Brachytherapy
| 0394T, 0395T, 77761, 77762, 77763, 77767, 77768, 77770, 77772, 77778
|
| Stereotactic radiation therapy
| 77371, 77372, 77373, G0339, G0340 |
| Intensity modulated radiation therapy (IMRT)
| 77385, 77386, G6015, G6016 |
| Neutron beam radiation therapy
| 77423 |
| Intraoperative radiation therapy (IORT) | 77424, 77425 |
| Proton beam radiation therapy | 77520, 77522, 77523, 77255 |
| Hyperthermia treatment | 77600, 77605, 77610, 77615, 77620 |
| Radiation treatment delivery | 77401, 77402, 77407, 77412, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014 |
| Image-guided radiation (IGRT)
| 77014, 77387, G6001, G6002, G6017 |
| Therapeutic radiopharmaceuticals
| 77750, 79005, C2616, S2095 |
What's next?
In the coming weeks, we'll share additional information to ensure you have ample opportunity to be trained on using EviCore’s online authorization portal and to ask any questions you may have. Additional information will include:
- FAQs
- Peer-to-peer and appeals information
- Training webinars
- And more