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

651–700 of 2,954, by type and title

PayerPolicy

EVICORE-MSK_ADVANCED-808885F42761

CMM-604: Posterior Cervical Fusion

EVICORE-MSK_ADVANCED-05A7143D8000

CMM-605 Cervical Microdiscectomy

EVICORE-MSK_ADVANCED-349D09E41180

CMM-605: Cervical Microdiscectomy

EVICORE-MSK_ADVANCED-ADCDAEB144FD

CMM-605: Cervical Microdiscectomy

Effective May 31, 2023

EVICORE-MSK_ADVANCED-E0D3F7751BCE

CMM-605: Cervical Microdiscectomy

Effective Sep 1, 2022

EVICORE-MSK_ADVANCED-4F6AB6BD9276

CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)

EVICORE-MSK_ADVANCED-B4E276C68F9A

CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)

EVICORE-MSK_ADVANCED-C190D153B09E

CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy)

Effective Sep 1, 2022

EVICORE-MSK_ADVANCED-CFFEC04C6BC2