New York
Provider Communications

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

• Conservative management – all sections
• Addition of physical therapy or home therapy requirement and one complementary modality for all spine procedures based on preponderance of benefit over harm to conservative care
• Lumbar Disc Arthroplasty
• Changed the duration of conservative management from 1 year to 6 months based on the FDA prospective study that was done to approve the lumbar disc arthroplasty procedure
• Added age, level requirements, and symptom/sign requirement and clarified contraindications in reflect these changes
• Added exclusions criteria of Prior spine surgery of any form at the target level
• Lumbar Fusion and Treatment of Spinal Deformity (including Scoliosis and Kyphosis)
• Inclusion for implant failure similar to cervical spine
• Consolidated  juvenile and congenital in adolescent idiopathic
• Decreased duration of conservative management required based on lower evidence for efficacy in spinal stenosis and specialty panel feedback
• Excluded anterior lumbar interbody fusion for foraminal stenosis without evidence of instability exclusion due to very low quality evidence for efficacy
• Lumbar Laminectomy
• Decreased duration of conservative care required for known spinal stenosis based on guidance from NASS and less evidence for efficacy of conservative management in this population
• Aligned conservative care duration with discectomy criteria
• Added new indication for synovial cyst
• Noninvasive Electrical Bone Growth Stimulation
• Clarification of guideline intent
• Allow active nicotine use as a risk factor in lumbar uses of bone growth stimulation
• Allow thoracic fusion similar to lumbar
• Bone Graft Substitutes and Bone Morphogenetic Proteins
• Allow active nicotine use as a risk factor for pseudoarthrosis in graft failure 

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.