Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*
Joint Surgery Updates by section:
- Shoulder Arthroplasty
- Added steroid injection for all joints exclusion based on panel recommendation
- Added exclusions for use of xenografts or biologic scaffold for augmentation or bridging reconstruction, use of platelet rich plasma or other biologics and concomitant subacromial decompression
- Removed indication for subacromial impingement with rotator cuff tear
- Hip arthroplasty
- Added exclusion for steroid injection for joint being replaced within the past 6 weeks
- Added labral tear indication
- Knee Arthroscopy and Open Procedures
- Added chondroplasty indication
- Narrowed use of lateral release to lateral compression as a cause for anterior knee pain or chondromalacia patella
- Added a conservative management and advanced osteoarthritis exclusion to patellar compression syndrome section
- Code changes
- Added CPT codes 27425, 27570
Spine Surgery Updates by section:
- No criteria changes
- Code changes only
- Added CPT codes 0200T, 0201T
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 email@example.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
February 2020 Anthem Provider News - Ohio