Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines. 

  • Sinusitis/rhinosinusitis
    • Expanded the scope of complicated sinusitis
    • Defined a minimal treatment requirement for uncomplicated sinusitis
    • Identified reasons for repeat sinus imaging, aligned with Choosing Wisely
    • Subacute sinusitis to be treated as more like acute or chronic rhinosinusitis based on the AAO-HNS acute sinusitis guideline
    • Defined indications for preoperative planning for image navigation following a clinical policy statement on appropriate use from the AAO-HNS
    • Removed CT screening for immunocompromised patients
  • Infectious disease – not otherwise specified
    • Added MRI TMJ to this indication
  • Inflammatory conditions – not otherwise specified
    • Allow MRI TMJ for suspected inflammatory arthritis following radiographs
  • Trauma
    • Radiograph requirement for suspected mandibular trauma
    • MRI TMJ in trauma for suspected internal derangement in surgical candidates
  • Neck mass (including lymphadenopathy)
    • Align adult neck imaging guideline with the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline
    • Expand definition of neck mass beyond palpable (seen on laryngoscopy)
    • Allow imaging for pediatric neck masses when initial ultrasound is not diagnostic
  • Parathyroid adenoma
    • Further defined the patient population that needs evaluation
    • Removed the requirement for aberrant anatomy in preoperative planning
    • Position CT as a diagnostic test after both ultrasound and parathyroid scintigraphy
    • Remove MRI as a modality to evaluate based on lack of evidence
  • Temporomandibular joint dysfunction
    • Removed standalone “frozen jaw” indication
    • Allow ultrasound in addition to radiographs as preliminary imaging
    • Allow advanced imaging without preliminary radiographs or US in the setting of mechanical signs or symptoms
    • Changed “Panorex” to “Radiographs” to allow for TMJ radiographs
    • Added requirement for conservative treatment and planned intervention for suspected osteoarthritis
  • Cerebrospinal fluid (CSF) leak of the skull base
    • Added modalities and criteria to evaluate for CSF leak
  • Dizziness or vertigo
    • Add Tullio’s phenomenon for lateral semicircular canal dehiscence
    • Expand definition of abnormal vestibular function testing
  • Hearing loss
    • Added indication for sudden onset hearing loss in adult patients
    • More clearly delineated appropriate modalities based on types of hearing loss in pediatric patients
    • Allow either CT or MRI for mixed hearing loss

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: 866-714-1107, Monday – Friday, 8:00 a.m. – 5:00 p.m.


Please note, this program does not apply to the Federal Employee Program® (FEP®), Taft-Hartley and BlueCard® Plans and programs.


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.

Featured In:
April 2019 Anthem New Hampshire Provider Newsletter