Updates to AIM Specialty Health advanced imaging clinical appropriateness guidelines

Updates by Guideline

 

• Imaging of the spine
  • Perioperative and periprocedural imaging – Added requirement for initial evaluation with radiographs
• Imaging of the extremities
  • Trauma – Added computerized tomography (CT) scan as an alternative to magnetic resonance imaging (MRI) for tibial plateau fracture; added indication for evaluation of supracondylar fracture
  • Rotator cuff tear – Combined acute and chronic rotator cuff tear criteria; standardized conservative management duration to 6 weeks
  • Shoulder arthroplasty – Modified language to clarify intent regarding limited scenarios where advanced imaging is indicated for total shoulder arthroplasty
  • Perioperative imaging – Excluded robotic-assisted hip arthroplasty as robotic-assisted surgery in general does not provide net benefit over conventional arthroplasty
• Vascular imaging
  • Stenosis or occlusion, extracranial carotid arteries – New indications for post neck irradiation, incidental carotid calcification scenarios
  • Stroke/Transient ischemic attack (TIA), extracranial evaluation – Subacute stroke/TIA; computed tomography angiography (CTA)/magnetic resonance angiography (MRA) neck allowed without prerequisite ultrasound (US), in alignment with 2021 American Heart Association (AHA)/American Stroke Association (ASA) guidelines
  • Chronic stroke/TIA – New indication; modality approach by circulation presentation
  • Pulmonary embolism – Removal of nondiagnostic chest radiograph (CXR) requirement (lower threshold for elevated D-dimer scenarios, thrombosis related to COVID-19 infection, etc.)
  • Imaging study modality and/or site expansion – Pulsatile tinnitus, acute aortic syndrome, abdominal venous thrombosis
  • Stenosis or occlusion, extracranial carotid arteries – Post-revascularization scenario aligned with the Society for Vascular Surgery (SVS) guidelines to allow annual surveillance regardless of residual stenosis.
  • Aneurysm of the abdominal aorta or iliac arteries – Management/surveillance scenarios aligned with SVS guidelines.
  • Upper or lower extremity peripheral arterial disease (PAD):
    • Suspected PAD without physiologic testing (including exercise testing) not indicated
    • New indication for Popliteal artery aneurysm US surveillance post-repair (2021 SVS guidelines)

 

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

• Access AIM’s ProviderPortal_℠ 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 Portal* at availity.com
• Call the AIM Contact Center toll-free number Monday through Friday from 8 a.m. to 8 p.m. Eastern time:
  • Indiana: 833-342-1252
  • Missouri: 833-775-1956
  • Ohio: 833-419-2143

 

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.

 

ABSCRNU-0327-22