MRIs*. com Abdomen Imaging Guidelines Abdomen Imaging Guidelines V1. 0 . CLINICAL GUIDELINES Cardiac Imaging Guidelines Version 2. eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. 0) CDP. After 2 years of stability, the finding should be assessed as benign (Cat 2). com Breast Imaging Guidelines. 2024 Pediatric Chest Imaging Age Dec 2, 2022 · This can often be best achieved by collecting data in the form of registries. proteins in the brain rather than amyloid. 2023 Heart disease in the pediatric population involves predominantly congenital lesions. - Under “Resources” in the top right-hand corner, select “ Clinical Guidelines ”. the benefits of a range of treatments, and compare alternative approaches quickly. Current. 2024 General Guidelines (PEDSP-1. Page 55 of 69 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 2024 Jan 4, 2024 · UnitedHealthcare uses evidence-based clinical guidelines from nationally recognized sources during review of our quality and health management programs. EviCore by Evernorth leverages our clinical expertise, evidence-based guidelines, and innovative technologies to deliver best-in-class medical benefit management solutions that inform more effective, affordable treatment and site of care decisions for each patient’s needs. To view all EviCore guidelines, type in “EviCore healthcare” as The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. FirstCarolinaCare is pleased to announce that we will be expanding our partnership with EviCore by Evernorth to include prior authorization management for Commercial and Medicare networks for Vascular Intervention services for dates of service January 1, 2024 and beyond. 3: Myocardial Sympathetic Innervation Imaging 61. 2023 A pertinent clinical evaluation including a detailed history, physical examination, appropriate laboratory studies and basic imaging such as plain radiography or ultrasound should be performed prior to considering advanced imaging (CT, MR, Feb 1, 2024 · Effective February 1, 2024. The EURECA Imaging Registry was created to evaluate the use of cardiac imaging for chronic coronary syndromes in Europe (and beyond)—the results of which are presented in the current issue of the European Heart Journal by Neglia and co-workers. com Chest Imaging Guidelines Chest Imaging Guidelines V2. 3D rendering, (CPT ® 76376/CPT ® 76377), should not be billed in conjunction with Cardiac CT and CCTA. com Oncology Imaging Guidelines. 2023 General Guidelines (PEDMS-1. 2024 A pertinent clinical evaluation since the onset or change in symptoms including a eviCore Durable Medical Equipment (DME) Guidelines Hi Tech Imaging and Cardiology Guidelines 2024 CPT 75580 Addendum to Cardiology & Radiology Imaging Guidelines . Nuclear medicine studies, including nuclear cardiology. evicore. Members should consult their member-specific benefit plan document for information regarding covered eviCore healthcare (eviCore) will begin accepting prior authorization requests for radiology services on December 17, 2020 for dates of service January 1, 2021 and after. the Pediatric Head Imaging Guidelines should be imaged according to the General Head Imaging Guidelines. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require Feb 12, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. For those Cardiac Imaging Guidelines V1. Feb 12, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. eviCore Healthcare has released an update to its evidenced-based clinical guidelines for cardiology and radiology imaging services that will be effective October 1, 2022. 1: CHF – Imaging 60 CD-9. Authorization is not required for procedures performed in an emergency room, observation unit, urgent care center or during an inpatient stay. Feb 1, 2024 · Pediatric Peripheral Vascular Disease (PVD) Imaging Guidelines V1. 0) PVDP. If the uterus rises out of the pelvic cavity, the imaging field can be determined on scout films. Additional literature summaries may be accessed by selecting ‘Supplemental Information’ and then entering “EviCore by Evernorth” in the search by health plan function. com Spine Imaging Guidelines Spine Imaging Guidelines V2. com Pelvis Imaging Guidelines Pediatric Pelvis Imaging Guidelines V1. Prior authorization requests will be reviewed based on eviCore clinical guideline criteria. EviCore is pleased to provide prior authorization services for CareFirst for dates of service July 22nd, 2024 and beyond. 2: Inguinal Lymphadenopathy 36 AB-8. 2024 BI-RADS TM Categories Chart (BR- Feb 1, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. com Cardiac Imaging Guidelines V2. 2: Palliative Care in patients with heart failure 61 CD-9. Findings indicate that alternatives to nuclear stress tests in cardiac imaging may accomplish the same results, but without exposing patients to potentially Jan 1, 2024 · Effective January 1, 2024. Runoff studies (CPT® 75635 for CTA or CPT® 74185, CPT® 73725, and CPT® 73725 for MRA) image from the umbilicus to the feet o CTA Abdomen and lower extremities should be reported as CPT® 75635, rather than using the individual CPT® codes for the abdomen, pelvis, and legs Page 58 of 91 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. com Pelvis Imaging Guidelines . Apr 1, 2024 · Guideline Development (Preface-1. GG. 2024 General Guidelines – Chest X-Ray (CH- Feb 1, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 2024 Effective April 1, 2024 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. eviCore reserves the right to change The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. Imaging Guidelines V2 . A probably benign lesion on MRI (MRI BI-RADSTM 3) should undergo repeat MRI in 6 months. A. Radiology. These guidelines include procedures eviCore does not review for Cigna. 3: Myocardial Sympathetic Innervation Imaging 60. All codes found on the EviCore. Cigna and eviCore reserve the right Oct 1, 2023 · MUGA 'multiple gated acquisition' cardiac nuclear scan 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. com Pediatric Chest Imaging Guidelines Pediatric Chest Imaging Guidelines V1. 0001. 3: Sclerosing Mesenteritis and Mesenteric Panniculitis 37. Individuals who are >18 years old should be imaged according to the General Head Imaging Guidelines, except where directed otherwise by a specific guideline section. Nov 1, 2023 · PRF. - Type in the relevant health plan. 2024 General Guidelines (AB-1. Additional information regarding current and upcoming programs can be Feb 12, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. ) Vascular malformations. 2024 References (PV-1) Johns Hopkins HealthCare LLC (JHHC) has partnered with eviCore healthcare to provide patients with access to high quality, medically appropriate care that is consistent with evidenced-based treatment guidelines. 2024 o Multi Gated Acquisition (MUGA) studies (CPT ® 78472, CPT ® 78473, CPT ® Preface to the Imaging Guidelines V2. Advanced imaging is not necessary. GENERAL RESOURCES. 1) The co-branded Cigna-eviCore healthcare (eviCore) evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including CT, MRI, PET, Gastrointestinal Endoscopy, as well as Cardiac, and musculoskeletal interventions. 2024 General Guidelines (PV-1. AB-8: Abdominal Lymphadenopathy AB-8. 2024 Abbreviations and Glossary for the PVD Imaging Guidelines v1. com Cardiac Imaging Guidelines Cardiac Imaging Guidelines V1. 2024 Procedure Coding (PVD-1. recommendations for treatment and should never be used as treatment guidelines. To speak with a Web Specialist, call (800) 646-0418 (Option #2) or email portal. 0) CareFirst Resources. For dates of service on or after January 1, 2024, please contact United Healthcare Choice at (877)585-9643, who will begin accepting 2024 authorization on December 1, 2023. Which members will eviCore healthcare manage for the Radiology and Cardiology program? EviCore will manage prior authorization for Vaya Health members who are enrolled in the following 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. FirstCarolinaCare Radiology & Cardiac Imaging Services Performed by eviCore Prior authorization does NOT apply to Radiology & Cardiac Imaging services performed in: eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for Excellus BCBS. - If needed, accept the disclaimer. Pediatric individuals can have acquired heart disease unique to children. 2024 CN I: Olfactory nerve (see Taste and Smell Disorders (HD-2. 4: PET Imaging in Oncology NOTE: Some payors have specific restrictions on PET imaging, and those coverage policies may supersede the recommendations for PET imaging in these guidelines. 24 months from the date of the initial imaging. PET scans. Some information in this coverage policy may not apply to all benefit plans administered by Cigna. Apr 1, 2024 · CLINICAL GUIDELINES Radiation Oncology Version 1. com Cardiac Imaging Guidelines V1. 0) Guideline development (Preface-1) The eviCore evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including CT, MRI, PET, and Radiation Oncology, Sleep Studies, and Cardiac and Spine interventions. MRAs*. 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. Cigna and eviCore reserve the right Apr 1, 2024 · Guideline Development (Preface-1. com Chest Imaging Guidelines Chest Imaging Guidelines V1. Cardiovascular; Comprehensive Oncology; Consumer Feb 1, 2024 · Guideline Development (Preface-1. FirstCarolinaCare Radiology & Cardiac Imaging Services Performed by eviCore Prior authorization does NOT apply to Radiology & Cardiac Imaging services performed in: Feb 1, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 2023 individual age, comorbidities, and differences in disease natural history between children and adults. EviCore healthcare (EviCore) is an independent specialty medical benefits management company that provides utilization management services for Vaya Health . Breast Ultrasound (BR-1) Guideline Page Aug 1, 2020 · Page 23 of 104 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. Additionally, EviCore employs industry-leading clinical guidelines, including pediatric-specific imaging guidelines that incorporate all applicable criteria from medical specialty societies. Recommendations contained in clinical practice guidelines are not a guarantee of coverage. 0) EviCore healthcare is pleased to provide prior authorization services for Summit Health for dates of service beginning January 1, 2021. Cigna and eviCore reserve the right to change and Aug 1, 2019 · CTA, heart, coronary arteries and bypass grafts (when present), with contrast, including 3D image post-processing (including 3D image post-processing, assessment of cardiac function, and evaluation of venous structures, if performed). com. See PVD-13. Jul 1, 2023 · MUGA 'multiple gated acquisition' cardiac nuclear scan 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 2024 General Guidelines (PEDPVD-1. com Pelvis Imaging Guidelines. MUGA 'multiple gated acquisition' cardiac nuclear scan 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. Enter your Health Plan name into the search field and click on the magnifying glass, then click on the corresponding guideline to open the guideline document (example: Neck Imaging Guidelines). ): CT Neck and/or Chest with or without contrast. 2023 General Guidelines (PEDCD-1. Which members will eviCore healthcare manage for the Radiology and Cardiology program? eviCore will manage prior authorization for Excellus members who are enrolled in the following programs: The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. May 17, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. com Head Imaging Guidelines Head Imaging Guidelines V2. P roce du re D i ag no sis Cardiac - Transthoracic Echo Imaging Request For NON-URGENT requests, please fax this completed document along with medical records, imaging, tests, etc. com PVD Imaging Guidelines Peripheral Vascular Disease (PVD) Imaging Guidelines V1. 0) eviCore healthcare and destroy the original transmission and its attachments without saving them in any manner. CPT codes: PET imaging in oncology should use PET/CT fusion imaging (CPT® 78815 or CPT® 78816) Unbundling PET/CT imaging into separate PET and Feb 1, 2024 · Guideline Development (Preface-1. Imaging studies, including CT and MRI, are unnecessary in most individuals with hoarseness because most hoarseness is self-limited or caused by pathology that can be identified by laryngoscopy alone. Cigna and eviCore reserve the right Ultrasound of the soft tissues of the neck including thyroid, parathyroid, parotid and other salivary glands, lymph nodes, cysts, etc. com Pediatric Cardiac Imaging Guidelines Pediatric Cardiac Imaging Guidelines V1. 3-D reconstruction (CPT® 76377) can be approved in this setting. 16. 1: CHF – Imaging 61 CD-9. support@evicore. 0 Effective September 1, 2021 eviCore healthcare Clinical Decision Support Tool Diagnostic. Cigna and eviCore reserve the right to change and update the guidelines. 1) PRF. The Radiology & Cardiovascular Imaging program will NOT include a post-service review. • Cardiac Imaging. is coded as CPT® 76536. 2024 o Multi Gated Acquisition (MUGA) studies (CPT ® 78472, CPT ® 78473, CPT ® Mar 1, 2024 · eviCore’s evidence-based guidelines State and federal legislations may need to be considered in the review of advanced imaging requests Clinical information (Preface-3) The philosophy behind eviCore guidelines entails using an evidence-based approach to determine the most appropriate procedure for each individual, at the Clinical Guidelines; Clinical Worksheets; Submit a New Prior Authorization; Check Status of Existing Prior Authorization; Upload Additional Clinical; Find Contact Information; Receive Technical Web Support; Request a Consultation with a Clinical Peer Reviewer; Podcasts; Solutions Solutions. CT Neck. com PVD Imaging Guidelines V2. com Abdomen Imaging Guidelines V1. Deep neck masses. - Choose the relevant Solution. Feb 1, 2024 · v1. com Breast Imaging Guidelines Breast Imaging Guidelines V2. 2) The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. The co-branded Cigna-eviCore healthcare (eviCore) evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including CT, MRI, PET, Gastrointestinal Endoscopy, as well as Cardiac, and musculoskeletal interventions. com Pediatric Spine Imaging Guidelines Pediatric Spine Imaging Guidelines V1. 2024 BI-RADS TM Categories Chart (BR- Pediatric Cardiac Imaging Guidelines V1. Did you know up to one-third of CTs and MRIs may be deemed unnecessary and carry radiation risks for patients? 1 And that 20%-50% of diagnostic imaging exams may be considered redundant? 2 EviCore’s Radiology solution ensures health plan members receive the most appropriate test or treatment necessary for their individual medical Aug 1, 2023 · Effective August 1, 2023. eviCore healthcare reserves the right to change and update the guidelines. Prior authorization will be required for the following services for their Commercial Fully Insured membership: • Advanced Imaging. individual’s condition, previous imaging showed an indeterminate finding, or eviCore healthcare guidelines support routine follow-up imaging. If the cause of the DVT is found to be due to May-Thurner, iliac vein angioplasty followed by stenting of the left iliac vein is generally performed. If repeat imaging remains BI-RADSTM 3, repeat at 12 months, 18 months and. com Pelvis Imaging Guidelines Pediatric Pelvis Imaging Guidelines V2. Feb 1, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 2: Palliative Care in patients with heart failure 60 CD-9. com Head Imaging Guidelines V2. This evidencebas- ed medical coverage policy has been developed by eviCore, Inc. MRI without contrast or CT without contrast is indicated when healing (including post-operative fixation) cannot be adequately assessed on follow-up plain x-rays. Our dedicated Web Support team can assist providers in navigating the portal and addressing any web-related issues during the online submission process. SOLUTION RESOURCES. 2024 General Guidelines (SP-1. 0. The result: Better outcomes and lower costs for patients, providers Feb 1, 2024 · PRF. eviCore healthcare (eviCore) will begin accepting prior authorization requests for radiology services on December 17, 2020 for dates of service January 1, 2021 and after. MRI Neck without and with contrast (CPT® 70543) is appropriate if CT suggests the need for further imaging or if ultrasound or CT suggests any of the following: Neurogenic tumor (schwannoma, neurofibroma, glomus tumor, etc. Onset tends to be younger (less than 65) and progression usually more rapid than in senile dementia-Alzheimer type (SDAT). Future. 2024 LAD left anterior descending coronary artery Pediatric Cardiac Imaging Guidelines V1. CD-9: Congestive Heart Failure CD-9. 1 Imaging, we cannot approve this request. 1) ) In the area of medical imaging, for example, these guidelines can help physicians assess the risks vs. Sep 1, 2021 · Page 101 of 101 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 3: May- Thurner Syndrome. 1) The cobranded Cigna-eviCore healthcare (eviCore) evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including CT, MRI, PET, Gastrointestinal Endoscopy, as well as Cardiac, and musculoskeletal interventions. 2024 General Guidelines – Chest X-Ray (CH- Feb 1, 2024 · eviCore healthcare guidelines support routine follow-up imaging. The uterus, tubes and ovaries arise out of the pelvis and are considered pelvic organs. 2023 Feb 1, 2024 · Perhipheral Vascular Disease (PVD) Imaging Guidelines V1. 2023 LV left ventricle LVEF left ventricular ejection fraction MI myocardial infarction MPI myocardial perfusion imaging (SPECT study, nuclear cardiac study) MRA magnetic resonance angiography MRI magnetic resonance imaging mSv millisievert (a unit of radiation exposure) equal to an effective dose of a joule of Aug 1, 2023 · eviCore’s guidelines) rather than using Local Coverage Determinations and other Medicare coverage policy Investigational and Experimental Studies o Certain imaging studies described in these guidelines are considered investigational by various payors, and their coverage policies may take precedence over eviCore’s guidelines The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. Pelvis Imaging Guidelines V2. 2024. Nov 1, 2023 · Guideline Development (Preface-1. 1. Starting January 1, 2024, authorizations for GEHA Lab procedures will be required from United Healthcare Choice Network and no longer through EviCore. The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. This can be helpful in more ill-defined masses or fullness and differentiating adenopathy from mass or cyst, to define further advanced imaging. Cigna and eviCore reserve the right Cardiac Imaging Guidelines Abbreviations for Cardiac Imaging Guidelines 3 Glossary 4 CD-1: General Guidelines 5 CD-2: Echocardiography (ECHO) 15 CD-3: Nuclear Cardiac Imaging 26 CD-4: Cardiac CT, Coronary CTA, and CT for Coronary Calcium (CAC) 33 CD-5: Cardiac MRI 42 CD-6: Cardiac PET 47 CD-7: Diagnostic Heart Catheterization 51 Sep 23, 2019 · Here’s a step-by-step guide for finding the right ones: - Visit: www. The eviCore healthcare (eviCore) evidence-based, proprietary clinical guidelines evaluate a range of advanced imaging and procedures, including NM, US, CT, MRI, PET, Radiation Oncology, Sleep Studies, Gastrointestinal Endoscopy, as well as Cardiac, musculoskeletal and Spine interventions. Providers can view the list of CPT codes that require prior authorizations, eviCore clinical guidelines, and other provider resources on the GEHA Resources. A v1. 13) in the Abdomen Imaging Guidelines. Plain x-rays initial imaging. Runoff studies (CPT® 75635 for CTA or CPT® 74185, CPT® 73725, and CPT® 73725 for MRA) image from the umbilicus to the feet o CTA Abdomen and lower extremities should be reported as CPT® 75635, rather Feb 12, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. o Individuals who are 18 years old or younger19 should be imaged according to the Pediatric Imaging Guidelines if discussed in the condition-specific guideline sections. Prior authorization will be required for the following services: • Advanced Imaging • Cardiac Imaging • Interventional Pain • Spine Surgery • Joint Surgery EviCore strives to promote appropriate use of diagnostic imaging by the Health Plan’s contracted primary care physicians, specialty physicians and other health care professionals in office settings, through the administration of the Self-Referral Payment Policies. Please visit the cardiology and radiology solutions page of eviCore’s website and click on the “Future” tab to view the updated guidelines applicable to 1199SEIU members. Feb 1, 2024 · MRI Neck is used less frequently than CT Neck. Imaging of the abdomen is not supported for problems suspected to arise from the pelvis. 0) MSP. C. Jan 1, 2021 · ONC -1. Laryngoscopy is the primary diagnostic modality for evaluating individuals with hoarseness. Overview. Notification and prior authorization may be required for these advanced outpatient imaging procedures: CT scans*. 2024 (See also: Cardiac Imaging Guidelines Glossary ) Abbreviati on Definition AAA Abdominal aortic aneurysm ABI Ankle brachial index: a noninvasive, non-imaging test for arterial insufficiency – (see toe-brachial The reason for denial states in your letter states: Based on EviCore Neck Imaging Guidelines Section: NECK 9. eviCore. If imaging is negative, or there is suspicion of a radiolucent foreign body (such as fish or chicken bones, wood, plastic, thin metal objects, aluminum can pop-ups, etc. 5 Feb 1, 2024 · If plain x-rays show a non-displaced osteochondral fragment, follow-up imaging should be with plain x-rays. Archived. 2024 Abbreviations for Oncology Imaging Guidelines NHL non-Hodgkin's lymphoma NPC nasopharyngeal carcinoma NSABP National Surgical Adjuvant Breast and Bowel Project NSAIDS nonsteroidal anti-inflammatory drugs NSCLC non-small cell lung cancer NSGCT non-seminomatous germ cell tumor PA posteroanterior Guideline Development (Preface-1. Page 59 of 93 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 0) Feb 14, 2020 · Page 34 of 156 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. EviCore's clinical guidelines are evidence-based and apply to the following categories of service for individuals with Cigna-administered plans: Computed Tomography (CT) and Computed Tomography Angiography (CTA) Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) Positron Emission Tomography (PET) Nuclear Cardiology. com - Wellmark-BCBS Solution- Feb 1, 2024 · 400 Buckwalter Place Boulevard, Bluffton, SC 29910 (800) 918-8924 www. 1: Abdominal Lymphadenopathy 36 AB-8. 2024 CPT 75580 Addendum to Cardiology & Radiology Imaging Guidelines. Oncology Imaging Guidelines V2. ag lf xx ig fh jx dq ci to et