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

Effective for dates of service on and after August 16, 2020, the following updates will apply to the AIM  Musculoskeletal Program: Interventional Pain Management Clinical Appropriateness Guideline.

 

Musculoskeletal Program: Interventional Pain Management Guideline updates by section:

 

General Requirements – Conservative Management

  • Addition of physical therapy or home therapy requirement and one complementary modality based on preponderance of benefit over harm to conservative care
  • Align with approach to conservative management defined in spine and joint surgery guidelines

 

Epidural Injection Procedures and Diagnostic Selective Nerve Root Blocks

  • Addition of statement about adherence to ESI procedural best practices established by FDA Safe Use Initiative. Recommendations are intended for provider education and will not be used for adjudication.
  • Clarification of intent around requirement for advanced imaging for repeat injections

 

Paravertebral Facet Injection/Nerve Block/Neurolysis

  • Remove indication for 4 unilateral medial branch blocks per session based on panel consensus

 

Paravertebral Facet Injection/Nerve Block/Neurolysis continued

  • Procedural clarification restricting use of corticosteroids for diagnostic MBB based on panel consensus
  • Limit use of intra-articular steroid injection to mechanical disruption of a facet synovial cyst
  • Remove indication for intra-articular steroid injections based on new evidence for lack of efficacy
  • Increase duration of initial RFN efficacy needed to avoid a MBB to 6 months based on panel consensus
  • Clarification that MBB or RFN is not medically necessary after spinal fusion

 

Spinal Cord and Nerve Root Stimulators

  • Clarify inclusion of different stimulation methods for spinal cord stimulation
  • Add new indication for dorsal root ganglion stimulation
  • Clarify exclusions for spinal cord and 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 ProviderPortalSM 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.

 

428-0520-PN-NY


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May 2020 Empire Provider News