AIM Specialty Health radiation oncology clinical guidelines updates

Effective for dates of service on and after January 28, 2019, the following updates will apply to the AIM Specialty Health© (AIM) radiation oncology clinical appropriateness guidelines. AIM is a separate company.

 

Breast cancer

• Removed age and tumor size criteria for accelerated whole breast irradiation (AWBI)

 

Rectal cancer

• Modified criteria no longer limits treatment with intensity modulated radiation therapy (IMRT) for rectal adenocarcinoma

 

Pancreatic cancer

• Added criteria for stereotactic body radiation therapy (SBRT) in treating locally advanced or recurrent disease without evidence of distant metastasis

 

Head and neck cancer

• Added criteria to allow IMRT for head and neck lymphomas
• Clarified no IMRT for stage I/II glottic cancer

 

Lung cancer

• Added dose volume histogram (DVH) parameter for cardiac V50

 

Sarcoma

• Removed preoperative and joint sparing requirements for IMRT

 

Prostate cancer

• Added discussion on hypofractionation
• Added discussion on brachytherapy

 

As a reminder, ordering and servicing providers may submit pre-service clinical review requests to AIM in one of several ways:

 

• Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
• Access AIM via the Availity Web Portal at availity.com.
• Call the AIM Contact Center toll-free number: 866-714-1107, 8:00 a.m. – 5:00 p.m.

 

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 on AIM’s website.

 

Please note, this program does not apply to the Federal Employee Program® (FEP®) or National Accounts.