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: 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 aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.


* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.


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February 2020 Anthem Provider News - Wisconsin