Update to AIM Specialty Health clinical appropriateness guidelines
Advanced imaging appropriate use criteria: Imaging of the heart
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, clinical appropriateness guidelines: advanced imaging appropriate use criteria: imaging of the heart:
Carotid duplex ultrasound
- Criteria removed for evaluation of syncope in patients with suspected extracranial arterial disease
- New criteria address evaluation of TAVR (TAVI) in patients with suspected or established extracranial arterial disease
Myocardial perfusion imaging (MPI), stress echocardiography, cardiac PET, and coronary CT angiography (CCTA)
- Clarifications address exercise-induced syncope and exercise-induced dizziness, lightheadedness or near syncope in symptomatic patients with suspected coronary artery disease
MPI, stress echocardiography, cardiac PET
- Criteria added to allow annual surveillance of coronary artery disease in patients with established CAD post-cardiac transplant
- Clarified definition of established coronary artery disease when diagnosed by CCTA
- More restrictive for patients diagnosed with coronary artery disease by prior coronary angiography, as FFR must be ≤0.8
- More permissive for patients diagnosed with coronary artery disease by CCTA with FFR ≤0.8 (patients previously excluded)
Resting transthoracic echocardiography (TTE)
- New criteria for evaluation of ventricular function in patients who have undergone cardiac transplantation.
- New criteria allows for annual study to quantify cardiac iron load in chronically ill patients with cardiomyopathy who require frequent blood transfusions (e.g., thalassemia)
- Removed allowance for annual LV function evaluation when echocardiography is suboptimal
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: 1-800-554-0580, Monday-Friday, 8:30 a.m.-7:00 p.m. ET.
For questions related to guidelines, please contact AIM via email at firstname.lastname@example.org. Additionally, you may access and download a copy of the current guidelines on AIM’s website.
Please note, this program does not apply to FEP.
October 2018 Anthem Wisconsin Provider Newsletter