Updates to AIM Spine Surgery Clinical Appropriateness Guideline*
- Conservative management – all sections
- Addition of physical therapy or home therapy requirement and one complementary modality for all spine procedures based on preponderance of benefit over harm to conservative care
- Lumbar Disc Arthroplasty
- Changed the duration of conservative management from 1 year to 6 months based on the FDA prospective study that was done to approve the lumbar disc arthroplasty procedure
- Added age, level requirements, and symptom/sign requirement and clarified contraindications in reflect these changes
- Added exclusions criteria of Prior spine surgery of any form at the target level
- Lumbar Fusion and Treatment of Spinal Deformity (including Scoliosis and Kyphosis)
- Inclusion for implant failure similar to cervical spine
- Consolidated juvenile and congenital in adolescent idiopathic
- Decreased duration of conservative management required based on lower evidence for efficacy in spinal stenosis and specialty panel feedback
- Excluded anterior lumbar interbody fusion for foraminal stenosis without evidence of instability exclusion due to very low quality evidence for efficacy
- Lumbar Laminectomy
- Decreased duration of conservative care required for known spinal stenosis based on guidance from NASS and less evidence for efficacy of conservative management in this population
- Aligned conservative care duration with discectomy criteria
- Added new indication for synovial cyst
- Noninvasive Electrical Bone Growth Stimulation
- Clarification of guideline intent
- Allow active nicotine use as a risk factor in lumbar uses of bone growth stimulation
- Allow thoracic fusion similar to lumbar
- Bone Graft Substitutes and Bone Morphogenetic Proteins
- Allow active nicotine use as a risk factor for pseudoarthrosis in graft failure
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.
* 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