Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines*

*Change to Prior Authorization Requirements

Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health_®* (AIM) Radiation Oncology Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.

• Radiation Therapy— Updates by section
  • Gastrointestinal (GI) Cancers — Intensity modulated radiation therapy (IMRT)
  • Removed plan comparison requirement for cholangiocarcinoma, esophageal, gastric, hepatocellular, and pancreatic cancer, because IMRT has become standard of care for curative treatment of these GI malignancies
• Oligometastatic Extracranial Disease— SBRT: stereotactic body radiation therapy (SBRT)
  • Added indication for adrenal metastases as SABR-COMET trial listed this as one of the most common sites treated in that trial
• Prostate Cancer— Brachytherapy:
  • Added indication for high-dose rate monotherapy in low- and intermediate-risk disease
• Image Guidance radiation therapy (IGRT)
  • Added surface-based guidance technique (no change in intent or coding)
  • Added statement that IGRT is not medically necessary to guide superficial radiotherapy for non-melanoma skin cancer (supported by American Society for Radiation Oncology [ASTRO] Clinical Practice Guideline)

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM through the AIM ProviderPortal_SM directly at www.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.

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you can access and download a copy of the current and upcoming guidelines here.