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.




  • 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.


  • 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.  


Featured In:
October 2018 Anthem Provider Newsletter - Virginia