I’ve treated over 1,000 patients with low-dose radiation for benign musculoskeletal conditions. Effective this November, EviCore will classify the treatment as not medically necessary for nearly all of them. Some context on how EviCore got here. In 2019, EviCore’s own published criteria stated: “Policy: Radiation therapy is medically necessary” for plantar fasciitis and osteoarthritis, citing response rates near 80% with durability at 48 weeks. That position held through early 2026. The new guideline describes the same literature as a “paucity of evidence.” No reconciliation of the two positions has been published. The cited sources don’t support the reversal either. The DEGRO guideline EviCore references recommends LDRT for refractory Kellgren 2–3 knee OA and grades plantar fasciitis radiotherapy at evidence level 1b, recommendation A. The 2024 VA evidence review found uncertainty on specific outcomes, not nonnecessity, and its literature search ended April 2023. The review is currently being updated as you are reading this. Since that cutoff: a randomized, multicenter, sham-controlled trial presented at ASTRO 2025 showed 70% response with 3 Gy versus 42% with sham (p=0.014) in knee OA — the study design the earlier skepticism specifically called for. And the American Radium Society published multispecialty Appropriate Use Criteria, developed with rheumatologists and orthopedic surgeons, defining when LDRT is and isn’t appropriate. I’ve applied strict evidence standards in my own AUC work, including voting against favorable ratings when randomized controlled data was lacking. This isn’t a plea for blanket coverage. It’s a request for basic consistency: an evidence review should account for the strongest available trial, accurately represent its cited sources, and explain what changed. The patients affected are refractory with failed conservative care, often not surgical candidates. Categorical noncoverage removes even individualized review for the exact population every cited guideline identifies as appropriate. Comment and appeal pathways are open through the November effective date. Our societies are engaged. If you treat these patients, now is the time to document and submit.