Update to AIM Specialty Health radiation oncology clinical appropriateness guidelines

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, radiation oncology clinical appropriateness guidelines:

 

Breast cancer

• Removed age and tumor size criteria for accelerated whole breast irradiation (AWBI).

 

Rectal cancer

• Modified criteria no longer limits treatment with IMRT for rectal adenocarcinoma.

 

 Pancreatic cancer

 

• Added criteria for SBRT in treating locally advanced or recurrent disease without evidence of distant metastasis.

 

Head and neck cancer

 

• Added criteria to allow IMRT for head and neck lymphomas.

 

• Clarified no IMRT for stage I/II glottic cancer.

 

Lung cancer

 

• Added DVH parameter for cardiac V50.

 

Sarcoma

 

• Removed preoperative and joint sparing requirements for IMRT.

 

Prostate cancer

                             

• Added discussion on hypofractionation.

 

• Added discussion on brachytherapy.

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 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) or National Accounts.