Jun 14, 2018 • Policy Updates

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 prior authorization 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 intraarticular facet joint injections and clarified requirement for conservative treatment between injections

 Sacroiliac joint injections:

  • Added HCPCS code G0260

 

Ordering and servicing providers may submit prior authorization requests to AIM in one of the following ways:

  • Access AIM 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: 1-866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET

 

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


Featured In:
June 2018 BCBSGa Provider Newsletter