Georgia
Provider Communications
Updates to AIM musculoskeletal program clinical appropriateness guidelines
Joint Surgery – updates by section
- Further defined criteria for home physical therapy
- Removed cognitive behavioral therapy as a conservative care modality for extremity
- Added indication for diagnostic arthroscopy
- Standardized radiographic criteria to align with lateral release criteria
- Adhesive capsulitis – added history of trauma or post-operative contracture as a requirement
- Tendinopathy – removed rotator cuff tear as a criterion for tenodesis/tenotomy in patients with a clinical exam who do not meet criteria for SLAP repair or have suggestive MRI findings
- Hip athroscopy – removed complementary alternative medicine as not typically done for the hip
- Arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) – removed age as an exclusion for FAIS but further define radiographic exclusions
- Unicompartmental knee arthroplasty/partial knee replacement – added degenerative change of the patellofemoral joint as a contraindication
- Arthroscopically assisted lysis of adhesions – added ligamentous or joint reconstruction criteria
- Added criteria for plica resection
Spine Surgery – updates by section
- Further defined criteria for home physical therapy
- Added standard conservative management requirement for instability to align with spinal stenosis indications
- Added new comprehensive indication for tethered cord syndrome
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 aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
Featured In:
June 2021 Anthem Provider News - Georgia