Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change

Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health_®* Cardiology Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate and affordable healthcare services.

Cardiac Imaging — Updates by section

Stress testing with imaging:

• Suspected coronary artery disease (CAD) without symptoms — Indications removed
• Suspected CAD with symptoms — Indications modified
• Need for testing determined by pretest probability
• Definition of chest pain expanded to include ischemic equivalent pain elsewhere
• Dyspnea included as standalone symptom
• Imaging modality to be selected by the treating physician
• Exercise preferred over pharmacologic testing in patients referred for stress testing with imaging
• Patients with atypical symptoms to undergo non-imaging stress testing (assuming capable of exercise and no precluding resting EKG abnormalities)
• Established CAD without symptoms — Indications removed
• Established CAD with symptoms — Indications removed

CT coronary angiography (CCTA):

• Indications added — Considerable expansion in use for evaluation of CAD (now a first-line modality)
• Indications added — Preoperative testing indications
• Indications added — Abnormal prior testing indications
• Indications removed — Suspected anomalous coronary arteries (basis for suspicion required)

Fractional Flow Reserve from CCTA (FFR-CT):

• Indication modified — 40% to 90% coronary stenosis in symptomatic patient who has failed guideline-directed medical therapy and has undergone CCTA within preceding 90 days

Stress Cardiac MRI:

• Indications added — Considerable expansion in use for evaluation of CAD (now a first-line modality)
• Indications added — Preoperative testing indications
• Indications added — Abnormal prior testing indications

Resting Cardiac MRI:

• Indication added — Fabry disease
• Indications modified — Suspected myocarditis (basis for suspicion required)
• Indications modified — Arrhythmogenic right ventricular dysplasia (ARVD) requirements clarified
• Indications modified — Suspected anomalous coronary arteries (basis for suspicion required)

Resting transthoracic echocardiography (TTE):

• Valvular heart disease — updated frequency of surveillance in patients with prosthetic valves and those who had transcatheter valve replacement/repair; removed requirement of valvular dysfunction for those who had surgical mitral valve repair; removed moderate/severe mitral regurgitation for those who had transcatheter mitral valve repair

Diagnostic Coronary Angiography:

• Indications modified — Clarification that patients with established CAD who have failed GDMT may undergo coronary angiography regardless of how initial diagnosis was made

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM by accessing AIM’s ProviderPortal_SM directly at www.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.

If you have 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 and upcoming guidelines here.