Effective for dates of service on and after June 29, 2019, the following updates will apply to the AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines. 

 

Sinusitis/rhinosinusitis
  • Expanded the scope of complicated sinusitis
  • Defined a minimal treatment requirement for uncomplicated sinusitis
  • Identified reasons for repeat sinus imaging, aligned with Choosing Wisely
  • Subacute sinusitis to be treated as more like acute or chronic rhinosinusitis based on the AAO-HNS acute sinusitis guideline
  • Defined indications for preoperative planning for image navigation following a clinical policy statement on appropriate use from the AAO-HNS
  • Removed CT screening for immunocompromised patients

Infectious disease – not otherwise specified
  • Added MRI TMJ to this indication

Inflammatory conditions – not otherwise specified
  • Allow MRI TMJ for suspected inflammatory arthritis following radiographs

Trauma
  • Radiograph requirement for suspected mandibular trauma
  • MRI TMJ in trauma for suspected internal derangement in surgical candidates

Neck mass(including lymphadenopathy)
  • Align adult neck imaging guideline with AAO-HNS guideline
  • Expand definition of neck mass beyond palpable (seen on laryngoscopy)
  • Allow imaging for pediatric neck masses when initial ultrasound is not diagnostic

Parathyroid adenoma
  • Further defined the patient population that needs evaluation
  • Removed the requirement for aberrant anatomy in preoperative planning
  • Position CT as a diagnostic test after both ultrasound and parathyroid scintigraphy
  • Remove MRI as a modality to evaluate based on lack of evidence

Temporomandibular joint dysfunction
  • Removed standalone “frozen jaw” indication
  • Allow ultrasound in addition to radiographs as preliminary imaging
  • Allow advanced imaging without preliminary radiographs or US in the setting of mechanical signs or symptoms
  • Changed “Panorex” to “Radiographs” to allow for TMJ radiographs
  • Added requirement for conservative treatment and planned intervention for suspected osteoarthritis

Cerebrospinal fluid (CSF) leak of the skull base
  • Added modalities and criteria to evaluate for CSF leak

Dizziness or vertigo
  • Add Tullio’s phenomenon for lateral semicircular canal dehiscence
  • Expand definition of abnormal vestibular function testing

Hearing loss
  • Added indication for sudden onset hearing loss in adult patients
  • More clearly delineated appropriate modalities based on types of hearing loss in pediatric patients
  • Allow either CT or MRI for mixed hearing loss

 

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 at (800) 554-0580, Monday through Friday, 8:30 a.m. to 7:00 p.m. ET.

 

Please note, this program does not apply to FEP.

 

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 here.

 



Featured In:
April 2019 Anthem Provider Newsletter - Wisconsin