Updates to AIM Radiation Therapy Clinical Appropriateness Guideline*
- Special Treatment Procedure and Special Physics Consult
- Removed oral cone endocavitary indication
- Intensity Modulated Radiation Therapy (IMRT), Stereotactic Radiosurgery (SRS) or Stereotactic Body Radiotherapy (SBRT) for bone metastases
- Broadened description of adjacent normal tissues which may be of concern.
- Single fraction treatment
- Removed poor performance status criteria
- Central Nervous System cancers
- Added evidence review
- Spine Lesions; Primary or Metastatic Lesions of the Spine, Metastatic Lesions in the Lung
- Added note calling out separate criteria for curative intent treatment of extracranial oligometastatic disease.
- SBRT in the treatment of extracranial oligometastatic disease
- Added new section with discussion and indications
- Prostate cancer – hypofractionation
- Added fractionation guideline with EBRT/IMRT.
- Prostate cancer – postoperative radiotherapy and SBRT
- Added indication based on ASTRO/ASCO/AUA recommendation
- Prostate cancer – use of hydrogel spacer
- Added discussion and medical necessity statement about hydrogel spacers for prostate irradiation
- CPT code changes
- Added 77316, 77295 and 55874
- Removed 77427
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 firstname.lastname@example.org. Additionally, you may access and download a copy of the current and upcoming guidelines here.
Please note, this program does not apply to FEP or National Accounts
* 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.
November 2019 Anthem Provider News - Wisconsin