State & FederalMedicaidJuly 31, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective October 1, 2020, Empire BlueCross BlueShield will transition the clinical criteria for medical necessity review of certain rehabilitative services to AIM Specialty Health®* Rehabilitative Service Clinical Appropriateness Guidelines as part of the AIM rehabilitation program. Reviewed services will include certain physical therapy, occupational therapy and speech therapy services.  

 

As part of this transition of clinical criteria, the following procedures will be subject to prior authorization as part of the AIM rehabilitation program: 

 

CPT® code

Description

90901

Biofeedback training by any modality (when done for medically necessary indications)

90912

Biofeedback training for bowel or bladder control, initial 15 minutes

90913

Biofeedback training for bowel or bladder control, additional 15 minutes

96001

Three-dimensional, video-taped, computer-based gait analysis during walking

0552T

Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional

S8940

Therapeutic horseback riding, per session

S8948

Treatment with low level laser (phototherapy) each 15 minutes

S9090

Vertebral axial decompression (lumbar traction), per session

20560

Needle insertion(s) without injection(s), 1 or 2 muscle(s)

20561

Needle insertion(s) without injection(s), 3 or more muscle(s)

97129

One-on-one therapeutic interventions focused on thought processing and strategies to manage activities

97130

Each additional 15 minutes (List separately in addition to code for primary procedure.)

92606

Therapeutic services for use of non-speech-generating device with programming

92609

Therapeutic services for use of speech-generating device with programming

92630

Hearing training and therapy for hearing loss prior to learning to speak

 

The following procedure will be removed from the program:

  • S9117: Back school, per visit

 

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 https://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 Portal* at https://www.availity.com.
  • Call the AIM Contact Center toll-free number at 1-800-714-0040 from 7 a.m. to 7 p.m. Eastern time.

 

If you have 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 at https://aimproviders.com/rehabilitation.

 

NYE-NU-0225-20 June 2020

PUBLICATIONS: August 2020 Empire Provider News