Material adverse change (MAC)

 

Effective for dates of service on and after March 13, 2022, the following guideline updates will apply to the AIM Specialty Health® (AIM) Advanced Imaging Clinical Appropriateness Guideline. Part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable health care services

 

Imaging of the brain

  • Acoustic neuroma – removed indication for CT brain and replaced with CT temporal bone
  • Meningioma – new guideline establishing follow-up intervals
  • Pituitary adenoma – removed allowance for CT following nondiagnostic MRI in macroadenoma
  • Tumor, not otherwise specified – added indication for management; excluded surveillance for lipoma and epidermoid without suspicious features

 

Imaging of the head and neck

  • Parathyroid adenoma – specified scenarios where surgery is recommended based on American Association of Endocrine Surgeons guidelines
  • Temporomandibular joint dysfunction – specified duration of required conservative management

 

Imaging of the heart

  • Coronary CT angiography – removed indication for patients undergoing evaluation for transcatheter aortic valve implantation/replacement who are at moderate coronary artery disease risk

 

Imaging of the chest

  • Pneumonia – removed indication for diagnosis of COVID-19 due to availability and accuracy of lab testing
  • Pulmonary nodule – aligned with Lung-RADS for follow-up of nodules detected on lung cancer screening CT

 

Imaging of the abdomen and pelvis

  • Uterine leiomyomata – new requirement for US prior to MRI; expanded indication beyond uterine artery embolization to include most other fertility-sparing procedures
  • Intussusception – removed as a standalone indication
  • Jaundice – added requirement for US prior to advanced imaging in pediatric patients
  • Sacroiliitis – defined patient population in whom advanced imaging is indicated (predisposing condition or equivocal radiographs)
  • Azotemia – removed as a standalone indication
  • Hematuria – modified criteria for advanced imaging of asymptomatic microhematuria based on AUA guideline
  • Diffuse liver disease – new indication for multiparametric MRI for fibrosis and hemochromatosis

 

 

Oncologic imaging

  • National Comprehensive Cancer Network (NCCN) recommendation alignments for breast cancer, Hodgkin & non-Hodgkin lymphoma, neuroendocrine tumor, melanoma, soft tissue sarcoma, testicular cancer, and thyroid cancers.
  • Cancer screening: new age parameters for pancreatic cancer screening; new content for hepatocellular carcinoma screening
  • Breast cancer: clinical scenario clarifications for diagnostic breast MRI and PET/CT

 

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: 877-291-0366, Monday–Friday, 7:00 a.m.–5:00 p.m. PT.

 

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.

 

1444-1221-PN-NV

 



Featured In:
December 2021 Anthem Provider News - Nevada