Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health®* Cardiology Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate and affordable healthcare services.

 

Cardiac Imaging — Updates by section

Stress testing with imaging:

  • Suspected coronary artery disease (CAD) without symptoms — Indications removed
  • Suspected CAD with symptoms — Indications modified
  • Need for testing determined by pretest probability
  • Definition of chest pain expanded to include ischemic equivalent pain elsewhere
  • Dyspnea included as standalone symptom
  • Imaging modality to be selected by the treating physician
  • Exercise preferred over pharmacologic testing in patients referred for stress testing with imaging
  • Patients with atypical symptoms to undergo non-imaging stress testing (assuming capable of exercise and no precluding resting EKG abnormalities)
  • Established CAD without symptoms — Indications removed
  • Established CAD with symptoms — Indications removed

 

CT coronary angiography (CCTA):

  • Indications added — Considerable expansion in use for evaluation of CAD (now a first-line modality)
  • Indications added — Preoperative testing indications
  • Indications added — Abnormal prior testing indications
  • Indications removed — Suspected anomalous coronary arteries (basis for suspicion required)

 

Fractional Flow Reserve from CCTA (FFR-CT):

  • Indication modified — 40% to 90% coronary stenosis in symptomatic patient who has failed guideline-directed medical therapy and has undergone CCTA within preceding 90 days

Stress Cardiac MRI:

  • Indications added — Considerable expansion in use for evaluation of CAD (now a first-line modality)
  • Indications added — Preoperative testing indications
  • Indications added — Abnormal prior testing indications

 

Resting Cardiac MRI:

  • Indication added — Fabry disease
  • Indications modified — Suspected myocarditis (basis for suspicion required)
  • Indications modified — Arrhythmogenic right ventricular dysplasia (ARVD) requirements clarified
  • Indications modified — Suspected anomalous coronary arteries (basis for suspicion required)

 

Resting transthoracic echocardiography (TTE):

  • Valvular heart disease — updated frequency of surveillance in patients with prosthetic valves and those who had transcatheter valve replacement/repair; removed requirement of valvular dysfunction for those who had surgical mitral valve repair; removed moderate/severe mitral regurgitation for those who had transcatheter mitral valve repair

 

Diagnostic Coronary Angiography:

  • Indications modified — Clarification that patients with established CAD who have failed GDMT may undergo coronary angiography regardless of how initial diagnosis was made


As a reminder, ordering and servicing providers may submit prior authorization requests to AIM by accessing AIM’s ProviderPortalSM directly at www.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.

 

If you have 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 here.

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.
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January 2023 Anthem Provider News - Virginia