Updates to AIM Musculoskeletal Program clinical appropriateness guidelines

Effective for dates of service on and after May 17, 2020, the following updates will apply to the AIM Musculoskeletal Program: Joint Surgery and Spine Surgery Clinical Appropriateness Guidelines.

 

Joint Surgery Updates by section: 
Shoulder Arthroplasty

• Added steroid injection for all joints exclusion based on panel recommendation
• Added exclusions for use of xenografts or biologic scaffold for augmentation or bridging reconstruction, use of platelet rich plasma or other biologics and concomitant subacromial decompression
• Removed indication for subacromial impingement with rotator cuff tear  

Hip arthroplasty

• Added exclusion for steroid injection for joint being replaced within the past 6 weeks
• Added labral tear indication

Knee Arthroscopy and Open Procedures

• Added chondroplasty indication
• Narrowed use of lateral release to lateral compression as a cause for anterior knee pain or chondromalacia patella
• Added a conservative management and advanced osteoarthritis exclusion to patellar compression syndrome section

Code changes

• Added CPT codes 27425, 27570

 

Spine Surgery Updates by section: 
No criteria changes
Code changes only

• Added CPT codes 0200T, 0201T

As a reminder, ordering and servicing providers may submit prior approval requests to AIM in one of several ways: 

• Access AIM’s ProviderPortal_SM 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.