Oct 1, 2018 • Products & Programs

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