AIM Musculoskeletal Program Clinical Appropriateness Guidelines updates

Beginning with dates of service on and after July 1, 2018, the following updates will apply to AIM Musculoskeletal Program Clinical Appropriateness Guidelines.

 

Spine surgery guideline: 

• Cervical decompression with or without fusion:
  • Added osteotomy and corpectomy definitions
  • Clarified implant/instrumentation failure
• Lumbar fusion and treatment of spinal deformity (including scoliosis and kyphosis):
  • Added osteotomy and corpectomy definitions
• Spinal stenosis:
  • Removed bilateral or wide decompression

 

Interventional pain management guideline: 

• Epidural injection procedures and diagnostic selective nerve root blocks:
  • Added pre-service clinical review exemption for CPT codes 62320 and 62322 when used for post-procedural pain with certain ICD-10-CM diagnoses
• Repeat therapeutic epidural steroid injections, clarified initial injection as therapeutic:
  • Clarified injection sessions for procedural requirements
• Paravertebral facet injection/nerve block/neurolysis:
  • Increased procedural limitation for diagnostic medial branch blocks
  • Increased procedural limitation for therapeutic intra-articular facet joint injections and clarified requirement for conservative treatment between injections
• Sacroiliac joint injections:
  • Added HCPCS code G0260

 

Ordering and servicing providers may submit pre-service clinical review requests to AIM in one of the following ways:

 

• Access AIM’s ProviderPortal available 24/7 to process orders in real-time
• Access AIM’s portal via the Availity Web Portal
• Contact AIM’s call center - 866-714-1107, 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 guidelines here.