New York
Provider Communications

Feb 1, 2019 • Policy Updates / Medical Policy & Clinical Guidelines

Spine Surgery - Enhancements as indicated by section below: 

• General Requirements

-Reporting of symptom severity: expanded to include IADLs as functional impairment

-Tobacco Cessation: removed nicotine-free documentation requirement

• Cervical Decompression with or without Fusion

-Added exclusion of cervical/thoracic laminectomy if criteria not met

• Lumbar Discectomy, Foraminotomy, and Laminotomy

-Added criteria to define radicular pain for Lumbar herniated intervertebral disc

• Lumbar Fusion and Treatment of Spinal Deformity (including scoliosis and Kyphosis)

-Added indication and criteria for Flat back Deformity

-Added criteria for Isthmic spondylolisthesis

-Added indication and criteria for Scheuermann’s Kyphosis

• Lumbar Laminectomy

-Added exclusion of lumbar laminectomy if criteria not met

• Noninvasive Electrical Bone Growth Stimulation

-Added risk factor criteria for cervical non-invasive bone growth stimulation

Interventional Pain Guidelines - Enhancements as indicated by section below: 

• General Requirements

-Reporting of symptom severity: expanded to include IADLs as functional impairment

• Therapeutic Epidural Steroid Injection

-Updated time period of initial advanced imaging

-Definition and frequency of repeat therapeutic epidural steroid injection

-Updated maximum number of annual injections

-Added criteria for subsequent injection after suboptimal initial response

• Paravertebral Facet Injection/Nerve Block/Neurolysis

-Updated injection frequency limitations

• Diagnostic Intraarticular Sacroiliac Joint Injections

-Updated pain reduction from initial injection

• Spinal Cord Stimulators

-Added criteria for revision/removal of spinal cord stimulator

-Separated criteria of trial stimulation and permanent stimulator implantation

-Added exclusion of dorsal root ganglion stimulation

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

• Access AIM’s ProviderPortallSM 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: 1-877-430-2288, Monday–Friday, 8:00 a.m.–6:00 p.m. ET.

Please note, this program does not apply to FEP or National Accounts.

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 guidelines here.