Update to AIM Specialty Health clinical appropriateness guidelines: Advanced imaging appropriate use criteria for imaging of the heart
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.
- More restrictive for patients diagnosed with coronary artery disease by prior coronary angiography, as FFR must be ≤0.8.
- 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.
- 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.
- Access AIM via the Availity Web Portal at availity.com.
- 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 email@example.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).
October 2018 Anthem Provider Newsletter - Virginia