Eviti®
Clinical Policies.
Clinical policy guidance on radiation therapy, oncology drug regimens, and oncology imaging, based on NCCN® and FDA standards and reviewed at least annually.
The policy documents open only after the AMA and NCCN terms on this page are accepted. Review the terms
About these policies
- NCCN® standards
- Primarily based on National Comprehensive Cancer Network® oncology standards.
- FDA standards
- Aligned with U.S. Food and Drug Administration standards.
- Reviewed at least annually
- Updated in a timely manner as NCCN and FDA guidance changes, and reviewed annually at a minimum.
NantIQ® provides clinical policy guidelines on radiation oncology treatments and oncology drug regimens. These drug regimens contain chemotherapeutic agents as well as supportive drugs utilized in conjunction with chemotherapy. These policies are primarily based on the National Comprehensive Cancer Network® (NCCN) oncology standards as well as the U.S. Food and Drug Administration (FDA) standards. NCCN consensus clinical standards are periodically updated, and NantIQ® reviews these and updates its policies within a timely manner. They are, at a minimum, reviewed annually if there are no periodic updates during the year from the NCCN or the U.S. FDA. Providers and members can view these oncology policies and guidelines for informational purposes as well as standards regarding dosages and treatment.
Codes and dosing tables
Procedure codes appearing in medical policy documents are only included as a general reference. The list may not be all-inclusive and is subject to updates. In addition, codes listed are not a guarantee of payment. The dosing tables in the policies represent evidence-based doses for the designated type of cancer drug or treatment. Variations outside of the ranges may indicate a deviation from standard treatments.
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AMA Disclaimer
CPT codes, descriptions, and other data are copyrighted by the American Medical Association (AMA). All rights are reserved for the date of publication of CPT. CPT is a trademark of the AMA.
Any use not authorized herein is prohibited. A license to use CPT for any use not authorized must be obtained through the AMA.
NCCN Disclaimer
All information provided by the National Comprehensive Cancer Network (NCCN) is “Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™) © 2024 and 2025 National Comprehensive Cancer Network. The NCCN Guidelines™ and illustrations herein may not be reproduced in any form for any purpose without the express written permission from the NCCN. To view the most recent and complete version of the NCCN Guidelines, please go online to NCCN.org.”
Available after acceptance
140 policy documents open once the terms are accepted.
- Radiation Therapy27 policies
- Medical Oncology85 policies
- Oncology Imaging28 policies
140 policies
Radiation Therapy
27 policies
- Anal Cancer (PDF, opens in a new tab)
- Bladder Cancer (PDF, opens in a new tab)
- Bone Metastases (PDF, opens in a new tab)
- Brachytherapy (PDF, opens in a new tab)
- Breast Cancer (PDF, opens in a new tab)
- Central Nervous System Cancer (PDF, opens in a new tab)
- Colon Rectal Cancer (PDF, opens in a new tab)
- Esophageal and Gastric Cancer (PDF, opens in a new tab)
- External Beam Radiation Treatment (PDF, opens in a new tab)
- Gynecologic Cancers (PDF, opens in a new tab)
- Head and Neck Cancer (PDF, opens in a new tab)
- Image-Guided Radiation Therapy (PDF, opens in a new tab)
- Intensity Modulated Radiation Therapy (PDF, opens in a new tab)
- Liver and Biliary Tract Cancer (PDF, opens in a new tab)
- Lung Cancer (PDF, opens in a new tab)
- Lymphoma (PDF, opens in a new tab)
- Other Cancers (PDF, opens in a new tab)
- Pancreatic Cancer (PDF, opens in a new tab)
- Primary Bone Cancer (PDF, opens in a new tab)
- Prostate Cancer (PDF, opens in a new tab)
- Proton Beam Therapy (PDF, opens in a new tab)
- Selective Internal Radiation Therapy (PDF, opens in a new tab)
- Skin Cancer (PDF, opens in a new tab)
- Soft Tissue Sarcoma (PDF, opens in a new tab)
- Stereotactic Body Radiation Therapy (PDF, opens in a new tab)
- Stereotactic Radiosurgery (PDF, opens in a new tab)
- Three Dimensional Confirmation Radiation (PDF, opens in a new tab)
No policies in this section match your filter.
Medical Oncology
85 policies
- Abemaciclib (PDF, opens in a new tab)
- Ado-Trastuzumab Emtansine (PDF, opens in a new tab)
- Afamitresgene Autoleucel (PDF, opens in a new tab)
- Aldesleukin (PDF, opens in a new tab)
- Amivantamab-vmjw (PDF, opens in a new tab)
- Arsenic Trioxide (PDF, opens in a new tab)
- Atezolizumab (PDF, opens in a new tab)
- Avelumab (PDF, opens in a new tab)
- Axicabtagene Ciloleucel (PDF, opens in a new tab)
- Azacitidine (PDF, opens in a new tab)
- Belinostat (PDF, opens in a new tab)
- Bendamustine HCL (PDF, opens in a new tab)
- Bevacizumab and Biosimilars (PDF, opens in a new tab)
- Blinatumomab (PDF, opens in a new tab)
- Bortezomib (PDF, opens in a new tab)
- Brentuximab Vedotin (PDF, opens in a new tab)
- Brexucabtagene Autoleucel (PDF, opens in a new tab)
- Brigatinib (PDF, opens in a new tab)
- Cabazitaxel (PDF, opens in a new tab)
- Carfilzomib (PDF, opens in a new tab)
- Cemiplimab-rwlc (PDF, opens in a new tab)
- Cetuximab (PDF, opens in a new tab)
- Ciltacabtagene Autoleucel (PDF, opens in a new tab)
- Daratumumab (PDF, opens in a new tab)
- Daratumumab and Hyaluronidase-fihj (PDF, opens in a new tab)
- Denosumab and Biosimilars (PDF, opens in a new tab)
- Dinutuximab (PDF, opens in a new tab)
- Dostarlimab-gxly (PDF, opens in a new tab)
- Durvalumab (PDF, opens in a new tab)
- Enfortumab Vedotin-ejfv (PDF, opens in a new tab)
- Epcoritamab-bysp (PDF, opens in a new tab)
- Erdafitinib (PDF, opens in a new tab)
- Fam-Trastuzumab Deruxtecan-nxki (PDF, opens in a new tab)
- Filgrastim and Biosimilars – Sargramostim – Tbo-filgrastim (PDF, opens in a new tab)
- Fulvestrant (PDF, opens in a new tab)
- General Oncology Drugs (PDF, opens in a new tab)
- Glofitamab-gxbm (PDF, opens in a new tab)
- Ibrutinib (PDF, opens in a new tab)
- Idecabtagene Vicleucel (PDF, opens in a new tab)
- Imatinib Mesylate (PDF, opens in a new tab)
- Inotuzumab Ozogamicin (PDF, opens in a new tab)
- Ipilimumab (PDF, opens in a new tab)
- Ivosidenib (PDF, opens in a new tab)
- Ixazomib (PDF, opens in a new tab)
- Larotrectinib (PDF, opens in a new tab)
- Lazertinib (PDF, opens in a new tab)
- Lenalidomide (PDF, opens in a new tab)
- Lenvatinib Mesylate (PDF, opens in a new tab)
- Lifileucel (PDF, opens in a new tab)
- Lisocabtagene Maraleucel (PDF, opens in a new tab)
- Loncastuximab Tesirine-lpyl (PDF, opens in a new tab)
- Lorlatinib (PDF, opens in a new tab)
- Lurbinectedin (PDF, opens in a new tab)
- Luspatercept-aamt (PDF, opens in a new tab)
- Nivolumab (PDF, opens in a new tab)
- Nivolumab and Hyaluronidase-nvhy (PDF, opens in a new tab)
- Nivolumab and Relatlimab-rmbw (PDF, opens in a new tab)
- Nogapendekin Alfa Inbakicept-pmln (PDF, opens in a new tab)
- Obecabtagene Autoleucel (PDF, opens in a new tab)
- Olaparib (PDF, opens in a new tab)
- Paclitaxel Albumin-Bound (PDF, opens in a new tab)
- Palbociclib (PDF, opens in a new tab)
- Panitumumab (PDF, opens in a new tab)
- Pegaspargase (PDF, opens in a new tab)
- Pegfilgrastim and Biosimilars (PDF, opens in a new tab)
- Pembrolizumab (PDF, opens in a new tab)
- Pertuzumab (PDF, opens in a new tab)
- Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (PDF, opens in a new tab)
- Ramucirumab (PDF, opens in a new tab)
- Rituximab and Biosimilars (PDF, opens in a new tab)
- Sacituzumab Govitecan-hziy (PDF, opens in a new tab)
- Tagraxofusp-erzs (PDF, opens in a new tab)
- Tarlatamab-dlle (PDF, opens in a new tab)
- Teclistamab-cqyv (PDF, opens in a new tab)
- Tisagenlecleucel (PDF, opens in a new tab)
- Tisotumab Vedotin-tftv (PDF, opens in a new tab)
- Toripalimab-tpzi (PDF, opens in a new tab)
- Trastuzumab and Biosimilars (PDF, opens in a new tab)
- Trastuzumab and Hyaluronidase-oysk (PDF, opens in a new tab)
- Tremelimumab-actl (PDF, opens in a new tab)
- Trifluridine and Tipiracil (PDF, opens in a new tab)
- Trilaciclib (PDF, opens in a new tab)
- Vimseltinib (PDF, opens in a new tab)
- Ziv-Aflibercept (PDF, opens in a new tab)
- Zoledronic Acid (PDF, opens in a new tab)
No policies in this section match your filter.
Oncology Imaging
28 policies
- Acute Lymphocytic Leukemia (ALL) (PDF, opens in a new tab)
- Acute Myeloid Leukemia (AML) (PDF, opens in a new tab)
- B-Cell Lymphomas (PDF, opens in a new tab)
- Biliary Tract Cancer (PDF, opens in a new tab)
- Bladder and Urothelial Cancer (PDF, opens in a new tab)
- Bone Sarcoma (PDF, opens in a new tab)
- Breast Cancer (PDF, opens in a new tab)
- Central Nervous System Cancer (PDF, opens in a new tab)
- Cervical Cancer (PDF, opens in a new tab)
- Colorectal Cancer (PDF, opens in a new tab)
- Cutaneous Melanoma (PDF, opens in a new tab)
- Esophageal Cancer (PDF, opens in a new tab)
- Gastric Cancer (PDF, opens in a new tab)
- General Oncology (PDF, opens in a new tab)
- Head and Neck Cancer (PDF, opens in a new tab)
- Hepatocellular Cancer (PDF, opens in a new tab)
- Hodgkin Lymphoma (PDF, opens in a new tab)
- Kidney Cancer (PDF, opens in a new tab)
- Lung Cancer (PDF, opens in a new tab)
- Multiple Myeloma (PDF, opens in a new tab)
- Occult (PDF, opens in a new tab)
- Ovarian Cancer (PDF, opens in a new tab)
- Pancreatic Cancer (PDF, opens in a new tab)
- Prostate Cancer (PDF, opens in a new tab)
- Soft Tissue Sarcoma (PDF, opens in a new tab)
- Testicular Cancer (PDF, opens in a new tab)
- Thyroid Cancer (PDF, opens in a new tab)
- Uterine Cancer (PDF, opens in a new tab)
No policies in this section match your filter.