Effective for dates of service on and after January 28, 2019, the following updates will apply to the AIM Specialty Health© (AIM), a separate company, radiation oncology clinical appropriateness guidelines.

Breast cancer

  • Removed age and tumor size criteria for accelerated whole breast irradiation (AWBI)

Rectal cancer

  • Modified criteria no longer limits treatment with IMRT for rectal adenocarcinoma

Pancreatic cancer

  • Added criteria for SBRT in treating locally advanced or recurrent disease without evidence of distant metastasis

Head and neck cancer

  • Added criteria to allow IMRT for head and neck lymphomas
  • Clarified no IMRT for stage I/II glottic cancer

Lung cancer

  • Added DVH parameter for cardiac V50
Sarcoma
  • Removed preoperative and joint sparing requirements for IMRT
Prostate cancer
  • Added discussion on hypofractionation
  • Added discussion on brachytherapy

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: 1-800-554-0580, Monday-Friday, 8:30 a.m.-7:00 p.m. ET.

 

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 on AIM’s website.

Please note, this program does not apply to FEP or National Accounts.



Featured In:
October 2018 Anthem Ohio Provider Newsletter