Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines

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.