Effective for dates of service on and after September 28, 2019, the following updates will apply to the AIM Advanced Imaging Clinical Appropriateness Guidelines. 

 

Brain Imaging Guideline contains updates to the following:

  • Infection
  • Multiple sclerosis and other white matter diseases
  • Movement disorders (Adult only)
  • Neurocognitive disorders (Adult only)
  • Trauma
  • Pituitary adenoma
  • Tumor
  • Hematoma or hemorrhage – intracranial or extracranial
  • Hydrocephalus/ventricular assessment
  • Pseudotumor cerebri
  • Spontaneous intracranial hypotension
  • Abnormality on neurologic exam
  • Ataxia
  • Dizziness or Vertigo
  • Headache
  • Hearing loss
  • Tinnitus

 

Extremity Imaging Guideline contains updates to the following:

  • Congenital or developmental anomalies of the extremity (Pediatric only)
  • Discoid meniscus (Pediatric only)
  • Soft tissue infection
  • Osteomyelitis
  • Septic arthritis
  • Bursitis
  • Capitellar osteochondritis
  • Fracture
  • Patellar dislocation
  • Patellar sleeve avulsion
  • Trauma complications
  • Bone lesions
  • Soft tissue mass – not otherwise specified
  • Lisfranc injury
  • Labral tear – hip
  • Labral tear – shoulder
  • Meniscal tear and ligament tear of the knee
  • Rotator cuff tear (Adult only)
  • Avascular necrosis
  • Lipohemarthrosis (Pediatric only)
  • Paget’s disease – new multimodality indication
  • General Perioperative Imaging (including delayed hardware failure) not otherwise specified

 

Spine Imaging Guideline contains updates to the following:

  • Multiple sclerosis or other white matter disease
  • Spinal infection
  • Cervical injury
  • Thoracic or lumbar injury
  • Paget’s disease
  • Spontaneous (idiopathic) intracranial hypotension (SIH)
  • Perioperative Imaging, including delayed hardware failure, not otherwise specified
  • Neck pain (cervical)
  • Mid-back pain (thoracic)

 

As a reminder, ordering providers may submit genetic testing 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 800-554-0580, 8:30 a.m.–7:00 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 guidelines on the Availity website.

* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.

 



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July 2019 Anthem Provider News - Kentucky