Effective for dates of service on and after May 17, 2020, the following updates will apply to the AIM Musculoskeletal Program: Joint Surgery and Spine Surgery Clinical Appropriateness Guidelines.


Joint Surgery Updates by section: 


  • Shoulder Arthroplasty
  • o Added steroid injection for all joints exclusion based on panel recommendation
  • o Added exclusions for use of xenografts or biologic scaffold for augmentation or bridging reconstruction, use of platelet rich plasma or other biologics and concomitant subacromial decompression
  • o Removed indication for subacromial impingement with rotator cuff tear  
  • Hip arthroplasty
  • o Added exclusion for steroid injection for joint being replaced within the past 6 weeks
  • o Added labral tear indication
  • Knee Arthroscopy and Open Procedures
  • o Added chondroplasty indication
  • o Narrowed use of lateral release to lateral compression as a cause for anterior knee pain or chondromalacia patella
  • o Added a conservative management and advanced osteoarthritis exclusion to patellar compression syndrome section
  • Code changes
    • o Added CPT codes 27425, 27570


Spine Surgery Updates by section: 

  • No criteria changes
  • Code changes only
  • o Added CPT codes 0200T, 0201T


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 at 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.

Featured In:
February 2020 Empire Provider News