Effective for dates of service on and after May 17, 2020, the following updates will apply to the AIM Musculoskeletal Program: Joint Surgery and Spine Surgery Clinical Appropriateness Guidelines.


Joint surgery updates by section: 


Shoulder arthroplasty


  • Added steroid injection for all joints exclusion based on panel recommendation


  • Added exclusions for use of xenografts or biologic scaffold for augmentation or bridging reconstruction, use of platelet rich plasma or other biologics and concomitant subacromial decompression


  • Removed indication for subacromial impingement with rotator cuff tear  


Hip arthroplasty


  • Added exclusion for steroid injection for joint being replaced within the past 6 weeks


  • Added labral tear indication


Knee arthroscopy and open procedures


  • Added chondroplasty indication


  • Narrowed use of lateral release to lateral compression as a cause for anterior knee pain or chondromalacia patella


  • Added a conservative management and advanced osteoarthritis exclusion to patellar compression syndrome section


Code changes


  • Added CPT codes 27425, 27570


Spine surgery updates by section:


No criteria changes


Code changes only


  • Added CPT codes 0200T, 0201T


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.

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 and upcoming guidelines.


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February 2020 Anthem Provider News - Virginia