New York
Provider Communications

Dec 1, 2020 • Policy Updates / Medical Policy & Clinical Guidelines

Chest Imaging and Head and Neck Imaging

• Hoarseness, dysphonia, and vocal cord weakness/paralysis – primary voice complaint
  • Require laryngoscopy for the initial evaluation of all patients with primary voice complaint

Brain Imaging and Head and Neck Imaging

• Hearing loss
  • Added CT temporal bone for evaluation of sensorineural hearing loss in any pediatric patients or in adults for whom MRI is nondiagnostic or unable to be performed
  • Higher allowed threshold for consecutive frequencies to establish SNHL
  • Remove CT brain as an alternative to evaluating hearing loss based on ACR guidance
• Tinnitus
  • Remove sudden onset symmetric tinnitus as an indication for advanced imaging

Head and Neck Imaging

• Sinusitis/rhinosinusitis
  • Add more flexibility for the method of conservative treatment in chronic sinusitis.
  • Require conservative management prior to repeat imaging for patients with prior sinus CT.
• Temporomandibular joint dysfunction
  • Removed requirement for radiographs/ultrasound
• Cerebrospinal fluid (CSF) leak of the skull base
  • Added scenario for management of known leak with change in clinical condition.

Brain Imaging

• Ataxia, congenital or hereditary
  • Combine with congenital cerebral anomalies to create one section
• Acoustic neuroma
  • More frequent imaging for a watch and wait or incomplete resection
  • New indication for Neurofibromatosis type 2 (NF 2)Neurofibromatosis type 2
  • More frequent imaging when MRI shows findings suspicious for recurrence
  • Single post-operative MRI following gross total resection
  • Include pediatrics with known acoustics (rare but NF 2)
• Tumor – not otherwise specified
  • Repurpose for surveillance imaging of low-grade neoplasms
• Seizure disorder and epilepsy
  • Limit imaging for the management of established generalized epilepsy
  • Require optimal medical management (aligning adult and pediatric language) prior to imaging for management in epilepsy
• Headache
  • Remove response to treatment as a primary headache red flag
• Mental status change and encephalopathy
  • Added requirement for initial clinical and lab evaluation to assess for a more specific cause

Oncologic Imaging

General enhancements: Updates to Scope/Definitions, general language standardization

General Content enhancements: Overall alignment with current national oncology guideline recommendations, resulting in:

• Removal of indications/parameters not addressed by NCCN
• Average risk inclusion criteria for CT Colonography
• New allowances for MRI Abdomen and/or MRI Pelvis by tumor type, liver metastatic disease
• New indications for Acute Leukemia (CT, PET/CT), Multiple Myeloma (MRI, PET/CT), Ovarian Cancer surveillance (CT), Bone Sarcoma (PET/CT)
• Updated standard imaging pre-requisites prior to PET/CT for Bladder/Renal Pelvis/Ureter, Colorectal, Esophageal/GE Junction, Gastric and Non-Small Cell Lung Cancers
• Additional PET/CT management scenarios for Cervical Cancer, Hodgkin Lymphoma

Other content enhancements by section:

• Cancer screening: New indication for Pancreatic Cancer screening
• Breast Cancer: New PET/CT indication for restaging/treatment response for bone-only metastatic disease and limitation of post-treatment Breast MRI after breast conserving therapy or unilateral mastectomy
• Prostate Cancer: MRI pelvis: removal of TRUS biopsy requirement, allowance if persistent/unexplained elevation in PSA or suspicious DRE
• Axumin PET/CT: Updated inclusion criteria (removal of general MRI pelvis requirement, additional allowance for rising PSA with non-diagnostic mpMRI)

• 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: 1-877-430-2288, Monday–Friday, 8:00 a.m.–6:00 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.

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