Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline
Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM Musculoskeletal Program: Interventional Pain Management Clinical Appropriateness Guideline.
Musculoskeletal Program: Interventional Pain Management Guideline updates by section:
General Requirements – Conservative Management
- Addition of physical therapy or home therapy requirement and one complementary modality based on preponderance of benefit over harm to conservative care
- Align with approach to conservative management defined in spine and joint surgery guidelines
Epidural Injection Procedures and Diagnostic Selective Nerve Root Blocks
- Addition of statement about adherence to ESI procedural best practices established by FDA Safe Use Initiative. Recommendations are intended for provider education and will not be used for adjudication.
- Clarification of intent around requirement for advanced imaging for repeat injections
Paravertebral Facet Injection/Nerve Block/Neurolysis
- Remove indication for 4 unilateral medial branch blocks per session based on panel consensus
Paravertebral Facet Injection/Nerve Block/Neurolysis continued
- Procedural clarification restricting use of corticosteroids for diagnostic MBB based on panel consensus
- Limit use of intra-articular steroid injection to mechanical disruption of a facet synovial cyst
- Remove indication for intra-articular steroid injections based on new evidence for lack of efficacy
- Increase duration of initial RFN efficacy needed to avoid a MBB to 6 months based on panel consensus
- Clarification that MBB or RFN is not medically necessary after spinal fusion
Spinal Cord and Nerve Root Stimulators
- Clarify inclusion of different stimulation methods for spinal cord stimulation
- Add new indication for dorsal root ganglion stimulation
- Clarify exclusions for spinal cord and dorsal root ganglion stimulation
As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortalSM 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: 866-789-0397, Monday - Friday, 8 a.m. to 5 p.m. ET.
May 2020 Anthem Provider News - Virginia