Nov 1, 2019 • Products & Programs

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 servicing providers may submit 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 at 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.


Featured In:
November 2019 Anthem Maine Provider News