Updates to AIM Spine Surgery Clinical Appropriateness Guideline*

Effective for dates of service on and after February 9, 2020, the following updates will apply to the AIM Musculoskeletal Program Spine Surgery Clinical Appropriateness Guidelines.

 

• 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 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.

 

* 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.