New York
Provider Communications

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

• Foreign body (Pediatric only), Gastrointestinal bleeding, Henoch-Schonlein purpura,Hematoma  or hemorrhage – intracranial or extracranial, Perianal fistula/abscess (fistula in ano), Ascites, Biliary tract dilatation or obstruction , Cholecystitis, Choledocholithiasis, Focal liver lesion, Hepatomegaly, Jaundice, Azotemia, Adrenal mass, indeterminate, Hematuria, Renal mass, Urinary tract calculi, Adrenal hemorrhage, Adrenal mass, Lymphadenopathy, Splenic hematoma, Undescended testicle (cryptorchidism)

• Abdominal and/or pelvic pain
• Combined pelvic pain with abdominal pain criteria in new “abdominal and/or pelvic pain” indication
• Required ultrasound or colonoscopy for select adult patients based on clinical scenario
• Ultrasound-first approach for pediatric abdominal and pelvic pain
• Lower extremity edema
• Added requirement to exclude DVT prior to abdominopelvic imaging
• Splenic mass, benign, Splenic mass, indeterminate, Splenomegaly
• Added new indications for diagnosis, management, and surveillance of splenic incidentalomas following the ACR White Paper (previously reviewed against “tumor, not otherwise specified”)
• Pancreatic mass
• Separated criteria for solid and cystic pancreatic masses
• Defined follow up intervals for cystic pancreatic masses
• Diffuse liver disease
• Added criteria for MR elastography
• Inflammatory bowel disease
• Limited requirement for upper endoscopy to patients with relevant symptoms
• New requirement for fecal calprotectin or CRP to differentiate IBS from IBD
• Enteritis or colitis, not otherwise specified
• Incorporated Intussusception (pediatric only),  and Ischemic bowel
• Prostate cancer
• Moved this indication to Oncologic Imaging Guideline
• CPT codes
• Added MR elastography CPT code 76391

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

• Access AIM’s ProviderPortall^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.