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.

 


  • 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