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.  This impacts clinical appropriateness guidelines – advanced imaging appropriate use criteria: imaging of the heart.


Carotid duplex ultrasound


  • Criteria removed for evaluation of syncope in patients with suspected extracranial arterial disease.


  • New criteria address evaluation of TAVR (TAVI) in patients with suspected or established extracranial arterial disease.


Myocardial perfusion imaging (MPI), stress echocardiography, cardiac PET, and coronary CT angiography (CCTA)


  • Clarifications address exercise-induced syncope and exercise-induced dizziness, lightheadedness or near syncope in symptomatic patients with suspected coronary artery disease.


MPI, stress echocardiography, cardiac PET


  • Criteria added to allow annual surveillance of coronary artery disease in patients with established CAD post-cardiac transplant.


  • Clarified definition of established coronary artery disease when diagnosed by CCTA.

  1. More restrictive for patients diagnosed with coronary artery disease by prior coronary angiography, as FFR must be ≤0.8.
  2. More permissive for patients diagnosed with coronary artery disease by CCTA with FFR ≤0.8 (patients previously excluded).


Resting transthoracic echocardiography (TTE)


  • New criteria for evaluation of ventricular function in patients who have undergone cardiac transplantation. 


Cardiac MRI

  • New criteria allows for annual study to quantify cardiac iron load in chronically ill patients with cardiomyopathy who require frequent blood transfusions (e.g., thalassemia).


  • Removed allowance for annual LV function evaluation when echocardiography is suboptimal.

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

  • Access AIM’s ProviderPortallSM 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.



  • Call the AIM Contact Center toll-free number: 866-789-0158, Monday – Friday, 8 a.m. to 5 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 the Federal Employee Program (FEP).

Featured In:
October 2018 Anthem Provider Newsletter - Virginia