This version of the policy will become effective 01/21/2020.
eviCore healthcare has revised their Radiation Therapy Clinical Guidelines. These guidelines will become effective 01/21/2020. These guidelines are available online at: https://www.evicore.com/resources/Pages/providers.aspx.
The following HCPCS codes were added to Attachment A of this policy: A4648, A4650, A9517, A9527, A9530, A9563, A9564, A9600, A9604, C1715, C1716, C1717, C1719, C2634, C2635, C2636, C2637, C2638, C2639, C2640, C2641, C2642, C2643, C2644, C2698, C2699, C9725, C9728
Note: On 12/04/2019, Attachment A of this policy was updated to incorporate coding changes effective 01/01/2020.
The following HCPCS code was added to Attachment A of this policy: A9590
The following HCPCS code was removed from Attachment A of this policy: C9408