Beginning with dates of service on and after July 1, 2018, the following updates will apply to AIM Musculoskeletal Program Clinical Appropriateness Guidelines.

 

Spine surgery guideline: 

  • Cervical decompression with or without fusion:
    • Added osteotomy and corpectomy definitions
    • Clarified implant/instrumentation failure
  • Lumbar fusion and treatment of spinal deformity (including scoliosis and kyphosis):
    • Added osteotomy and corpectomy definitions
  • Spinal stenosis:
    • Removed bilateral or wide decompression

 

Interventional pain management guideline: 

  • Epidural injection procedures and diagnostic selective nerve root blocks:
    • Added pre-service clinical review exemption for CPT codes 62320 and 62322 when used for post-procedural pain with certain ICD-10-CM diagnoses
  • Repeat therapeutic epidural steroid injections, clarified initial injection as therapeutic:
    • Clarified injection sessions for procedural requirements
  • Paravertebral facet injection/nerve block/neurolysis:
    • Increased procedural limitation for diagnostic medial branch blocks
    • Increased procedural limitation for therapeutic intra-articular facet joint injections and clarified requirement for conservative treatment between injections
  • Sacroiliac joint injections:
    • Added HCPCS code G0260

 

Ordering and servicing providers may submit pre-service clinical review requests to AIM in one of the following ways:

 

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines here.

 



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June 2018 Connecticut newsletter