Effective for dates of service on and after March 14, 2021, the following updates will apply to the AIM Radiation Oncology Clinical Appropriateness Guidelines.   

 

Radiation oncology

  • Special treatment procedure
    • Removed IV requirement for chemotherapy

CNS cancer 

  • IMRT for glioblastomas, other gliomas and metastases: Eliminated the 3D plan comparison requirement. Same change for high-grade and low-grade gliomas.
  • IMRT for metastatic brain lesions: Added hippocampal sparing whole brain radiotherapy indication

Lung cancer 

  • Eliminated the plan comparison requirement for IMRT to treat stage III non-small cell lung cancer.
  • SBRT: Removed “due to a medical contraindication” language
  • SBRT: Added “as an alternative to surgical resection” to stereotactic body radiation therapy
  • Adjusted fractionation maximum for curative treatment of non-small cell lung cancer up to 35 treatments of thoracic radiotherapy.

 

Proton beam therapy

  • Added new indication for hepatocellular carcinoma and intrahepatic cholangiocarcinoma


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 AIM’s Contact Center toll-free number at 866-714-1107, Mon. - Fri., 8:00 a.m. - 5:00 p.m.

 

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.

 

802-1220-PN-NE

 



Featured In:
December 2020 Anthem New Hampshire Provider News