As previously communicated in a Partners in Health UpdateSM article, effective July 1, 2019, AIM Specialty Health® (AIM) is using updated Clinical Appropriateness Guidelines for Radiology for AmeriHealth members.
AmeriHealth has contracted with AIM to perform utilization management activities for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services for our managed care members. AIM uses the Clinical Appropriateness Guidelines for Radiology to determine the medical necessity for these services. To view AIM’s current guidelines, go to the Resources section of AIM’s website.
Summary of the changes
As of July 1, 2019, the following changes were implemented to the Clinical Appropriateness Guidelines for Radiology:
- Head and neck imaging
- Sinusitis/rhinosinusitis
- Infectious disease – not otherwise specified
- Inflammatory conditions – not otherwise specified
- Trauma
- Neck mass (including lymphadenopathy)
- Parathyroid adenoma
- Temporomandibular joint dysfunction
- Cerebrospinal fluid (CSF) leak of the skull base
- Dizziness or vertigo
- Hearing loss
Policies and guidelines
The following policies were posted as Notifications on April 1, 2019, and are effective as of July 1, 2019. These policies include a list of procedure codes and a link to the radiology guidelines on AIM’s website:
- AmeriHealth New Jersey: #09.00.46w: High-Technology Radiology Services (New Jersey)
- AmeriHealth Pennsylvania: #09.00.46w: High-Technology Radiology Services (Pennsylvania)
To access these medical policies, visit our Medical Policy Portal.