Updates to AIM Radiation Therapy Clinical Appropriateness Guideline

Effective for dates of service on and after February 9, 2020, the following updates will apply to the AIM Radiation Therapy Clinical Appropriateness Guidelines. 

• Special Treatment Procedure and Special Physics Consult
  • Removed oral cone endocavitary indication
• Intensity Modulated Radiation Therapy (IMRT), Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiotherapy (SBRT) for bone metastases
  • Broadened description of adjacent normal tissues which may be of concern.
• Single fraction treatment
  • Removed poor performance status criteria
• Central Nervous System cancers
  • Added evidence review
• Spine Lesions; Primary or Metastatic Lesions of the Spine, Metastatic Lesions in the Lung
  • Added note calling out separate criteria for curative intent treatment of extracranial oligometastatic disease.
• SBRT in the treatment of extracranial oligometastatic disease
  • Added new section with discussion and indications
• Prostate cancer – hypofractionation
  • Added fractionation guideline with EBRT/IMRT.
• Prostate cancer – postoperative radiotherapy and SBRT
  • Added indication based on ASTRO/ASCO/AUA recommendation
• Prostate cancer – use of hydrogel spacer
  • Added discussion and medical necessity statement about hydrogel spacers for prostate irradiation
• CPT code changes
  • Added 77316, 77295 and 55874
  • Removed 77427

As a reminder, ordering and servincing providers may submit prior authorization 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 on the AIM website.

 

Please note, this program does not apply to FEP or National Accounts