Material adverse change (MAC)

Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health®* (AIM) Radiation Oncology 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 health care services.

  • Radiation Therapy — Updates by section
    • Gastrointestinal (GI) Cancers — Intensity modulated radiation therapy (IMRT)
    • Removed plan comparison requirement for cholangiocarcinoma, esophageal, gastric, hepatocellular, and pancreatic cancer, because IMRT has become standard of care for curative treatment of these GI malignancies
  • Oligometastatic Extracranial Disease — SBRT: stereotactic body radiation therapy (SBRT)
    • Added indication for adrenal metastases as SABR-COMET trial listed this as one of the most common sites treated in that trial
  • Prostate Cancer — Brachytherapy:
    • Added indication for high-dose rate monotherapy in low- and intermediate-risk disease
  • Image Guidance radiation therapy (IGRT)
    • Added surface-based guidance technique (no change in intent or coding)
    • Added statement that IGRT is not medically necessary to guide superficial radiotherapy for non-melanoma skin cancer (supported by American Society for Radiation Oncology [ASTRO] Clinical Practice Guideline)

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM through the AIM ProviderPortalSM directly at www.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.

 

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you can access and download a copy of the current and upcoming guidelines here.

* 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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Featured In:
January 2023 Anthem Provider News - Nevada