This communication applies to Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield (Anthem).

Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health® (AIM)* Musculoskeletal — Interventional Pain Management Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.

 

Interventional pain management — updates by section:

  • Epidural steroid injections:
    • For nerve root compression due to herniated disc, specified that the MRI/CT showing this finding must have been done within 18 months instead of 12 months.
  • Selective nerve root block:
    • Included a second session for cases requiring evaluation of more than one level.
  • Therapeutic intra-articular facet injections:
    • Included criteria for repeat injections in patients who met criteria for an initial injection.
  • Conservative management requirements:
    • Aligned definitions with joint surgery, spine surgery, spine, and extremity imaging guidelines.
    • More rigorous definition of the supervised home physical therapy requirement and removed cognitive behavioral therapy as a conservative care modality.
    • Included activity modification and a trial of rest.
  • Epidural steroid injections:
    • Specified that only one spinal region may be treated per date of service.
    • For repeat injection, prior injection must have provided improvement for three months instead of three weeks.
  • Diagnostic medial branch block:
    • Specified that up to four diagnostic sessions may be done in a rolling 12-month period (previously three).
    • Reduced the number of unilateral levels that may be done in a session from three to two.
  • Thermal medial branch radiofrequency neurotomy:
    • Reduced the number of unilateral levels that may be done in a session from three to two.
    • Specified a maximum of two radiofrequency sessions per rolling 12-month period.
  • Regional sympathetic nerve block:
    • Specified that procedure must be performed using imaging guidance.
    • Specified that the procedure must be performed unilaterally.
    • Specified a lifetime maximum of six blocks.
    • Removed exclusions that referred to procedures which are no longer performed.

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM:
  • Through 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.

 

If you have 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 online.


* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.
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January 2023 Anthem Provider News - Missouri