Maine
Provider Communications

May 1, 2020 • Products & Programs

Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM  Musculoskeletal Program: Interventional Pain Management Clinical Appropriateness Guideline.

Musculoskeletal Program: Interventional Pain Management Guideline:

General requirements – conservative management

• Addition of physical therapy or home therapy requirement and one complementary modality based on preponderance of benefit over harm to conservative care
• Align with approach to conservative management defined in spine and joint surgery guidelines

Epidural injection procedures and diagnostic selective nerve root blocks

• Addition of statement about adherence to ESI procedural best practices established by FDA Safe Use Initiative. Recommendations are intended for provider education and will not be used for adjudication.
• Clarification of intent around requirement for advanced imaging for repeat injections

Paravertebral facet injection/nerve block/neurolysis

• Remove indication for 4 unilateral medial branch blocks per session based on panel consensus
• Procedural clarification restricting use of corticosteroids for diagnostic MBB based on panel consensus
• Limit use of intra-articular steroid injection to mechanical disruption of a facet synovial cyst
• Remove indication for intra-articular steroid injections based on new evidence for lack of efficacy
• Increase duration of initial RFN efficacy needed to avoid a MBB to 6 months based on panel consensus
• Clarification that MBB or RFN is not medically necessary after spinal fusion

Spinal cord and nerve root stimulators

• Clarify inclusion of different stimulation methods for spinal cord stimulation
• Add new indication for dorsal root ganglion stimulation
• Clarify exclusions for spinal cord and dorsal root ganglion stimulation

As a reminder, ordering and servicing 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: 866-714-1107, Monday – Friday, 8:00 a.m. – 5:00 p.m.

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.

428-0520-PN-NE