Material Adverse Change (MAC)

Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health®* (AIM) Radiation Oncology Clinical Appropriateness Guidelines. As part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable healthcare services.

  • Radiation Therapy — Updates by section
    • Gastrointestinal (GI) Cancers — Intensity modulated radiation therapy (IMRT)
    • Removed plan comparison requirement for cholangiocarcinoma, esophageal, gastric, hepatocellular, and pancreatic cancer, because IMRT has become standard of care for curative treatment of these GI malignancies
  • Oligometastatic Extracranial Disease — SBRT: stereotactic body radiation therapy (SBRT)
    • Added indication for adrenal metastases as SABR-COMET trial listed this as one of the most common sites treated in that trial
  • Prostate Cancer — Brachytherapy:
    • Added indication for high-dose rate monotherapy in low- and intermediate-risk disease
  • Image Guidance radiation therapy (IGRT)
    • Added surface-based guidance technique (no change in intent or coding)
    • Added statement that IGRT is not medically necessary to guide superficial radiotherapy for non-melanoma skin cancer (supported by American Society for Radiation Oncology [ASTRO] Clinical Practice Guideline)


As a reminder, ordering and servicing providers may submit prior authorization requests to AIM through the AIM ProviderPortalSM directly at

  • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

For questions related to guidelines, please contact AIM via email at Additionally, you can access and download a copy of the current and upcoming guidelines here.

* AIM Specialty Health is an independent company providing some utilization review services on behalf of Empire BlueCross BlueShield.


Featured In:
January 2023 Newsletter