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Get EviCore Healthcare Lumbar Spine Fusion - LSF

Osistencies with the medical office records, please elaborate in the comment section. Failure to provide all relevant information may delay the determination. Requests may also be submitted via the web at eviCore.com. URGENT (same day) REQUESTS MUST BE SUBMITTED BY PHONE TO 877-917-2583. First Name: Middle Initial: DOB (mm/dd/yyyy ): Gender: Street Address: City: State: Facility/Site Female Zip: Home Phone: Cell Phone: Primary Contact: Health Plan: Member ID: Group ID: First Name.

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