Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline*
Musculoskeletal Program: Interventional Pain Management Guideline updates by section:
General Requirements – Conservative Management
- Addition of physical therapy or home therapy requirement and one complementary modality based on preponderance of benefit over harm to conservative care
- Align with approach to conservative management defined in spine and joint surgery guidelines
Epidural Injection Procedures and Diagnostic Selective Nerve Root Blocks
- Addition of statement about adherence to ESI procedural best practices established by FDA Safe Use Initiative. Recommendations are intended for provider education and will not be used for adjudication.
- Clarification of intent around requirement for advanced imaging for repeat injections
Paravertebral Facet Injection/Nerve Block/Neurolysis
- Remove indication for 4 unilateral medial branch blocks per session based on panel consensus
Paravertebral Facet Injection/Nerve Block/Neurolysis continued
- Procedural clarification restricting use of corticosteroids for diagnostic MBB based on panel consensus
- Limit use of intra-articular steroid injection to mechanical disruption of a facet synovial cyst
- Remove indication for intra-articular steroid injections based on new evidence for lack of efficacy
- Increase duration of initial RFN efficacy needed to avoid a MBB to 6 months based on panel consensus
- Clarification that MBB or RFN is not medically necessary after spinal fusion
Spinal Cord and Nerve Root Stimulators
- Clarify inclusion of different stimulation methods for spinal cord stimulation
- Add new indication for dorsal root ganglion stimulation
- Clarify exclusions for spinal cord and dorsal root ganglion stimulation
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: 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 firstname.lastname@example.org. Additionally, you may access and download a copy of the current and upcoming guidelines here.
May 2020 Anthem Provider News - Ohio