Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline (MAC)
Effective for dates of service on and after March 13, 2022, the following updates will apply to the AIM Specialty Health® (AIM) Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline. As part of the AIM guideline annual review process, the following updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable health care services.
Epidural injection procedures (ESI) and diagnostic selective nerve root blocks (SNRB):
- Allow more frequent ESI in newly diagnosed patients
- Remove imaging requirement in certain circumstances
- Require similar criteria as ESI for diagnostic SNRB
- Add epidural abscess as a contraindication
- Limit multilevel and combination diagnostic SNRB
Paravertebral facet injection/medial branch block (MBB)/neurolysis:
- Limit indefinite use of diagnostic MBB
- Add indication for diagnostic pars defect MBB
- Expand exceptions allowed for intraarticular facet injections
- Define MBB timing with respect to radiofrequency neurotomy, MBB limited to RFA candidacy
- Limit open surgical neurolysis, and limited multiple spinal injections
Sacroiliac joint injections:
- Limit indefinite use of diagnostic intraarticular injections
- Disallow sacral lateral branch blocks
- Disallow sacroiliac joint therapeutic injections in a previously fused joint
Spinal cord and nerve root stimulators:
- Allow minimally invasive pain procedures to satisfy conservative management definition
- Specify timing of mental health evaluation
- Define indications for repeat stimulator trial
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.
December 2021 Anthem Provider News - Georgia