Updates to AIM Advanced Imaging clinical appropriateness guideline
Advanced Imaging of the Chest updates by section:
Tumor or Neoplasm
- Allowed follow up of nodules less than 6 mm in size seen on incomplete thoracic CT, in alignment with follow up recommendations for nodules of the same size seen on complete thoracic CT
- Added new criteria for which follow up is indicated for mediastinal and hilar lymphadenopathy
- Separated mediastinal/hilar mass from lymphadenopathy, which now has its own entry
Parenchymal Lung Disease – not otherwise specified
- Removed as it is covered elsewhere in the document (parenchymal disease in Occupational lung diseases and pleural disease in Other thoracic mass lesions)
Interstitial lung disease (ILD), non-occupational including idiopathic pulmonary fibrosis (IPF)
- Defined criteria warranting advanced imaging for both diagnosis and management
Occupational lung disease (Adult only)
- Moved parenchymal component of asbestosis into this indication
- Added Berylliosis
Chest Wall and Diaphragmatic Conditions
- Removed screening indication for implant rupture due to lack of evidence indicating that outcomes are improved
- Limited evaluation of clinically suspected rupture to patients with silicone implants
Oncologic Imaging updates by section:
- New indication for BIA-ALCL
- New indication for pathologic nipple discharge
- Further define the population of patients most likely to benefit from preoperative MRI
Breast cancer screening
- Added new high risk genetic mutations appropriate for annual breast MRI screening
Lung cancer screening
- Added asbestos-related lung disease as a risk factor
As a reminder, ordering and servicing providers may submit prior authorization 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: 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET.
For questions related to guidelines, please contact AIM via email at firstname.lastname@example.org. Additionally, you may access and download a copy of the current and upcoming guidelines here.
May 2020 Anthem Provider News - Georgia