EviCore by Evernorth coverage policies

2,954 active EviCore by Evernorth policies in Backwork, grouped by policy type. Each policy page shows the codes the policy lists and links to the payer’s own copy.

Summary of the payer’s published policy. Not a coverage determination — confirm with EviCore by Evernorth before submitting.

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Policies

601–650 of 2,954, by type and title

PayerPolicy

EVICORE-MSK_ADVANCED-4DE519271E98

CMM-402: Greater Occipital Nerve Block

Effective May 31, 2023

EVICORE-MSK_ADVANCED-5B380573F742

CMM-402: Greater Occipital Nerve Block

Effective Jul 1, 2021

EVICORE-MSK_ADVANCED-ABB894D82929

CMM-402: Greater Occipital Nerve Block

Effective Aug 1, 2022

EVICORE-MSK_ADVANCED-EC46B738808E

CMM-402: Greater Occipital Nerve Block

Effective Aug 1, 2024

EVICORE-MSK_ADVANCED-01BEC40BBC8C

CMM-402: Greater Occipital Nerve Injections and Ablation

EVICORE-MSK_ADVANCED-7753F98E3DEE

CMM-402: Greater Occipital Nerve Injections and Ablation

EVICORE-MSK_ADVANCED-00A3B806C366

CMM-403: Neurolytic Agent Creation of Lesion

EVICORE-MSK_ADVANCED-30E6FF016555

CMM-403: Neurolytic Agent Creation of Lesion

Effective Jul 1, 2021