Effective January 10, 2021, Independence is updating our policies on Musculoskeletal Services to communicate the use of AIM Specialty Health® (AIM) Medical Necessity guidelines for select interventional pain management and spinal and joint surgical procedures with the exception of artificial intervertebral lumbar disc insertion for Independence Commercial and Medicare Advantage members. Previously, we followed our medical policies for all of these services.
The current policies on Musculoskeletal Services will remain in place for Independence Administrators.
Additionally, effective January 10, 2021, CPT® code 22862 will be considered experimental/investigational, and, therefore, not covered. This code will not be part of the Musculoskeletal Services utilization program with AIM; it will reside in the following new policies:
- Commercial: #11.15.31: Artificial Intervertebral Lumbar Disc Insertion
- Medicare Advantage: #MA11.114: Artificial Intervertebral Lumbar Disc Insertion
For more information, please refer to the following Independence policies, which will be posted as Notifications on October 12, 2020, and will go into effect on January 10, 2021:
- #00.01.66c: Musculoskeletal Services (Independence)
- #11.14.19p: Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)
- #11.15.31: Artificial Intervertebral Lumber Disc Insertion (Independence and Independence Administrators)
- #MA00.047c: Musculoskeletal Services
- #MA11.114: Artificial Intervertebral Lumbar Disc Insertion
To view the Notifications for these policies, visit our Medical and Claim Payment Policy Portal.