Effective October 1, 2020, Empire BlueCross BlueShield will transition the clinical criteria for medical necessity review of certain rehabilitative services to AIM Specialty Health®* Rehabilitative Service Clinical Appropriateness Guidelines as part of the AIM rehabilitation program. Reviewed services will include certain physical therapy, occupational therapy and speech therapy services.  


As part of this transition of clinical criteria, the following procedures will be subject to prior authorization as part of the AIM rehabilitation program: 


CPT® code



Biofeedback training by any modality (when done for medically necessary indications)


Biofeedback training for bowel or bladder control, initial 15 minutes


Biofeedback training for bowel or bladder control, additional 15 minutes


Three-dimensional, video-taped, computer-based gait analysis during walking


Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional


Therapeutic horseback riding, per session


Treatment with low level laser (phototherapy) each 15 minutes


Vertebral axial decompression (lumbar traction), per session


Needle insertion(s) without injection(s), 1 or 2 muscle(s)


Needle insertion(s) without injection(s), 3 or more muscle(s)


One-on-one therapeutic interventions focused on thought processing and strategies to manage activities


Each additional 15 minutes (List separately in addition to code for primary procedure.)


Therapeutic services for use of non-speech-generating device with programming


Therapeutic services for use of speech-generating device with programming


Hearing training and therapy for hearing loss prior to learning to speak


The following procedure will be removed from the program:

  • S9117: Back school, per visit


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 https://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 Portal* at https://www.availity.com.
  • Call the AIM Contact Center toll-free number at 1-800-714-0040 from 7 a.m. to 7 p.m. Eastern time.


If you have 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 at https://aimproviders.com/rehabilitation.


NYE-NU-0225-20 June 2020

Featured In:
August 2020 Empire Provider News