Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*

Effective for dates of service on and after May 17, 2020, the following updates will apply to the AIM Musculoskeletal Program: Joint Surgery and Spine Surgery 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 ProviderPortal_SM 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 aim.guidelines@aimspecialtyhealth.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.}