eviCore Prior Authorization: Portal, Phone Numbers and Guidelines

eviCore reviews imaging, cardiology, radiation therapy, musculoskeletal and other requests for many health plans. If the patient's plan uses eviCore, the prior authorization is submitted to eviCore, not to the plan.

How the guidelines work

• Guidelines are published by body area (head, spine, chest, abdomen, pelvis, musculoskeletal, cardiac, oncology, breast, neck, peripheral nerve, peripheral vascular) with separate pediatric versions, and are versioned with an effective date.
• Each guideline section has a code such as SP-5.1; reviewers and denial letters refer to these codes.
• Several versions can be posted at once: the one in effect now and one with a future effective date.

Plans covered on this site that use eviCore

• Aetna: Aetna hands advanced imaging reviews to eviCore. Radiology and cardiology requests are started on the eviCore portal, not on Availity.
• Cigna: Cigna uses eviCore for advanced radiology imaging, diagnostic cardiology, radiation therapy and musculoskeletal precertification.
• UnitedHealthcare: UnitedHealthcare runs its outpatient radiology prior authorization program through its own provider portal, using eviCore imaging guidelines for commercial and exchange plans.

Before you submit

1. Look up the study by CPT code on this site to see which guideline sections apply and the conditions they cover.
2. Read the current version of that section on the reviewer's site; the effective date is on the document.
3. Make sure the clinical notes cover what the section asks for: symptoms and duration, exam findings, earlier imaging, treatments tried and the response.
4. Submit on the portal with the CPT and ICD-10 codes matching the notes.
5. If denied, the letter will cite a section code. Answer that section directly in the appeal or peer-to-peer call.

Checked against evicore.com on September 29, 2026.