New York
Provider Communications

May 30, 2018 • Products & Programs

Beginning with dates of service on and after July 1, 2018, the following updates will apply to AIM Musculoskeletal Program Clinical Appropriateness Guidelines:

Spine Surgery guideline: 

• Cervical decompression with or without fusion:

o    Added osteotomy and corpectomy definitions

o    Clarified implant/instrumentation failure

• Lumbar fusion and treatment of spinal deformity (including scoliosis and kyphosis):

o    Added osteotomy and corpectomy definitions

• Spinal stenosis:

o    Removed bilateral or wide decompression

Interventional Pain Management guideline: 

• Epidural injection procedures and diagnostic selective nerve root blocks:

o    Added prior authorization exemption for CPT codes 62320 and 62322 when used for post-procedural pain with certain ICD-10-CM diagnoses

• Repeat therapeutic epidural steroid injections, clarified initial injection as therapeutic:

o    Clarified injection sessions for procedural requirements

• Paravertebral facet injection/nerve block/neurolysis:

o    Increased procedural limitation for diagnostic medial branch blocks

o    Increased procedural limitation for therapeutic intraarticular facet joint injections and clarified requirement for conservative treatment between injections

• Sacroiliac joint injections:

o    Added HCPCS code G0260

Ordering and servicing providers may submit prior authorization requests to AIM in one of the following ways:

• Access AIM 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 guidelines here.