Medical Policies
By accessing our medical policies you signify your agreement to our Terms of Use. Learn more about how medical policies are developedOpen a PDF and about experimental & investigational procedures .
For certain member contracts, the Health Plan has delegated utilization management of the following services to eviCore Healthcare MSI, LLC d/b/a eviCore Healthcare: implantable cardiac devices, radiology/imaging, radiation therapy, and musculoskeletal services (large joint replacement, pain management, and spine services). The Health Plan has adopted eviCore’s medical policies and guidelines as a basis for the determination of medical necessity and appropriateness of care.
Please refer member-specific questions to the Customer Care number on the back of the member card. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.
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Medical Policy Terms of Use
Our Medical Policies contain Physician Current Procedural Terminology ("CPT"), a coding work of nomenclature and five-digit codes for reporting of physician services. CPT is protected by copyright and trademark owned by the American Medical Association ("AMA").
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- This license shall terminate without notice if you violate its terms.
