Anthem Updates AIM Advanced Imaging Clinical Appropriateness Guidelines

July 2019 ~

Effective for dates of service on and after September 28, Anthem will apply certain updates to the AIM Advanced Imaging Clinical Appropriateness Guidelines. These updates can be seen below.

Brain Imaging Guideline contains updates to the following:

Infection, multiple sclerosis and other white matter diseases, movement disorders (adult only),  neurocognitive disorders  (adult only), trauma, pituitary adenoma, tumor, hematoma  or hemorrhage – intracranial or extracranial, Hydrocephalus/ventricular assessment, pseudotumor cerebri, spontaneous intracranial hypotension, abnormality on neurologic exam, ataxia, dizziness or vertigo, headache, hearing loss and tinnitus.

Extremity Imaging Guideline contains updates to the following:  

Congenital or developmental anomalies of the extremity (pediatric only), discoid meniscus (pediatric only), soft tissue infection, osteomyelitis, septic arthritis, bursitis, capitellar osteochondritis, fracture, patellar dislocation, patellar sleeve avulsion, trauma complications, bone lesions, soft tissue mass – not otherwise specified, lisfranc injury, labral tear – hip, labral tear – shoulder, meniscal tear and ligament tear of the knee, rotator cuff tear (adult only), avascular necrosis, lipohemarthrosis (pediatric only), Paget’s disease – new multimodality indication and general perioperative imaging (including delayed hardware failure), not otherwise specified.

Spine Imaging Guideline contains updates to the following:  

Multiple sclerosis or other white matter disease, spinal infection, cervical injury, thoracic or lumbar injury, Paget’s disease, spontaneous (idiopathic) intracranial hypotension  (SIH), perioperative imaging, including delayed hardware failure, not otherwise specified, neck pain (cervical), mid-back pain (thoracic)

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s Provider Portal_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 at 866-714-1107, Monday–Friday, 8:00 a.m.–5:00 p.m.

For more information on these updates, access and download a copy of the current guidelines here.

Source(s): Anthem;