Updates to AIM Radiation Therapy Clinical Appropriateness Guideline*

Effective for dates of service on and after February 9, 2020, the following updates will apply to the AIM Radiation Therapy Clinical Appropriateness Guidelines.

 

• 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 ProviderPortal_SM 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.

 

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.