Effective July 1, 2019, AIM Specialty Health^® (AIM) will be using updated Clinical Appropriateness Guidelines for Arterial Ultrasound for AmeriHealth members.

AmeriHealth has contracted with AIM to perform utilization management activities for cardiovascular tests/diagnostic procedures and nonsurgical treatments for obstructive coronary artery disease for our managed care members. AIM will use the updated Clinical Appropriateness Guidelines for Arterial Ultrasound to determine the medical necessity for these services. To view AIM’s current and future guidelines, go to the Resources section of AIM’s website.

Summary of the changes

Effective July 1, 2019, the following changes will be implemented to the Clinical Appropriateness Guidelines for Arterial Ultrasound:

• Duplex Ultrasound Imaging of the Arteries of the Upper Extremities
• Indication added for creation of arteriovenous fistulae for dialysis.
• Duplex Ultrasound Imaging of the Arteries of the Lower Extremities
• A 2016 American College of Cardiology guideline for management of peripheral arterial disease indicates that duplex imaging should be performed only after the decision to revascularize has been made. There is no role for duplex imaging in the initial diagnosis of peripheral arterial disease. AIM’s current guideline is not aligned with this position and the proposed changes address that malalignment.
• Language changed to account for the fact that critical limb ischemia should also include individuals with non-healing ulcers and gangrene.

Policy and guidelines

Medical Policy #11.02.27b: Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound was posted as a Notification on April 1, 2019, and will go into effect on July 1, 2019. The policy includes a list of procedure codes and a link to the current and future cardiology guidelines on AIM’s website.

To view the Notification for this policy, visit our Medical Policy Portal. Select Accept and Go to Medical Policy Online, and then select Active Notifications.