The following updates will apply to the AIM Clinical Appropriateness Guidelines for Advanced Imaging for claims with dates of service on and after March 14, 2021.


Chest imaging, and head and neck imaging

  • Hoarseness, dysphonia and vocal cord weakness/paralysis - primary voice complaint:
    • Required laryngoscopy for the initial evaluation of all patients with primary voice complaint


Brain imaging, and head and neck imaging

  • Hearing loss:
    • Added CT temporal bone for evaluation of sensorineural hearing loss in any pediatric patients or in adults for whom MRI is non-diagnostic or unable to be performed
    • Higher allowed threshold for consecutive frequencies to establish sensorineural hearing loss
    • Removed CT brain as an alternative to evaluating hearing loss based on ACR guidance
  • Tinnitus:
    • Removed sudden onset symmetric tinnitus as an indication for advanced imaging


Head and neck imaging

  • Sinusitis/rhinosinusitis:
    • Added more flexibility for the method of conservative treatment in chronic sinusitis
    • Required conservative management prior to repeat imaging for patients with prior sinus CT
  • Temporomandibular joint dysfunction:
    • Removed requirement for radiographs/ultrasound
  • Cerebrospinal fluid (CSF) leak of the skull base:
    • Added scenario for management of known leak with change in clinical condition


Brain imaging

  • Ataxia, congenital or hereditary:
    • Combined with congenital cerebral anomalies to create one section
  • Acoustic neuroma:
    • More frequent imaging for a watch and wait or incomplete resection
    • New indication for neurofibromatosis type 2 (NF 2)Neurofibromatosis type 2
    • More frequent imaging when MRI shows findings suspicious for recurrence
    • Single post-operative MRI following gross total resection
    • Included pediatrics with known acoustics (rare but NF 2)
  • Tumor - not otherwise specified:
    • Repurposed for surveillance imaging of low grade neoplasms
  • Seizure disorder and epilepsy:
    • Limited imaging for the management of established generalized epilepsy
    • Required optimal medical management (aligning adult and pediatric language) prior to imaging for management in epilepsy
  • Headache:
    • Removed response to treatment as a primary headache red flag
    • Include pregnancy as a red flag risk factor
  • Mental status change and encephalopathy:
    • Added requirement for initial clinical and lab evaluation to assess for a more specific cause


Oncologic imaging

  • General enhancements - Updates to Scope/Definitions, general language standardization
  • General content enhancements - Overall alignment with current National Comprehensive Cancer Network (NCCN) recommendations, resulting in:
    • Removal of indications/parameters not addressed by NCCN
    • Average risk inclusion criteria for CT colonography
    • New allowances for MRI abdomen and/or MRI pelvis by tumor type, liver metastatic disease
    • New indications for acute leukemia (CT, PET/CT), multiple myeloma (MRI, PET/CT), ovarian cancer surveillance (CT), bone sarcoma (PET/CT)
    • Updated standard imaging prerequisites prior to PET/CT for bladder/renal pelvis/ureter, ectal, esophageal/GE junction, gastric and non-small cell lung cancers
    • Additional PET/CT management scenarios for cervical cancer, Hodgkin Lymphoma

Other content enhancements by section

  • Cancer screening: New indication for pancreatic cancer screening
  • Breast cancer: New PET/CT indication for restaging/treatment response for bone-only metastatic disease and limitation of post-treatment breast MRI after breast conserving therapy or unilateral mastectomy
  • Prostate cancer: MRI pelvis: removal of TRUS biopsy requirement, allowance if persistent/unexplained elevation in PSA or suspicious DRE
  • Axumin PET/CT: Updated inclusion criteria (removal of general MRI pelvis requirement, additional allowance for rising PSA with non-diagnostic mpMRI)



Featured In:
January 2021 Anthem New Hampshire Provider News