MUSCULOSKELETAL

Anthem Medical Policies for Musculoskeletal

Document # Medical Policy Title
SURG.00052 Percutaneous Vertebral Disc and Vertebral Endplate Procedures
SURG.00053 Unicondylar Interpositional Spacer
SURG.00071 Percutaneous and Endoscopic Spinal Surgery
SURG.00072 Lysis of Epidural Adhesions
SURG.00092 Implanted Devices for Spinal Stenosis
SURG.00111 Axial Lumbar Interbody Fusion
TRANS.00035 Other Stem Cell Therapy

AIM Clinical Guidelines for Musculoskeletal

Interventional Pain Management

For commercial and Medicare members

OPEN THE INTERVENTIONAL PAIN MANAGEMENT GUIDELINES FOR COMMERCIAL/MEDICARE EFFECTIVE NOVEMBER 6, 2022

For Medicaid members

OPEN THE INTERVENTIONAL PAIN MANAGEMENT GUIDELINES EFFECTIVE MARCH 13, 2022

For commercial, Medicare, and Medicaid members

COMING SOON INTERVENTIONAL PAIN MANAGEMENT GUIDELINES EFFECTIVE APRIL 9, 2023

 

Joint Surgery

For commercial, Medicare, and Medicaid members except Indiana Medicaid

OPEN THE JOINT SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022

For Indiana Medicaid members

OPEN THE JOINT SURGERY GUIDELINES EFFECTIVE SEPTEMBER 12, 2021

 

Small Joint Surgery

For commercial members

OPEN THE SMALL JOINT SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022 

 

Spine Surgery

For commercial, Medicare, and Medicaid members except Indiana Medicaid

OPEN THE SPINE SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022

For Indiana Medicaid members

OPEN THE SPINE SURGERY GUIDELINES EFFECTIVE JANUARY 1, 2022

 

Sacroiliac Joint Fusion

For commercial, Medicare, and Medicaid members except Indiana Medicaid

OPEN THE SACROILIAC JOINT FUSION GUIDELINES EFFECTIVE SEPTEMBER 11, 2022

For Indiana Medicaid members

OPEN THE SACROILIAC JOINT FUSION GUIDELINES EFFECTIVE SEPTEMBER 12, 2021 

Medical policy SURG.00127 Sacroiliac Joint Fusion was archived effective July 30, 2021

 

Level of Care for Musculoskeletal Surgery and Procedures

OPEN THE GUIDELINES FOR LEVEL OF CARE EFFECTIVE JANUARY 1, 2022

 

Please note the Medicaid and Medicare dates are reflective of programs that AIM manages.  Medicare and Medicaid markets that aren’t managed by AIM may still utilize this criteria and the effective dates for the criteria will be noted in the market’s provider notice.

Code cross-reference guide

Download a helpful spreadsheet to find current and archived procedure codes for each solution!

Anthem medical policy site:

For a complete listing of medical policies, please go to Anthem Provider site > select your state > Scroll down page, select Review Policies > view Medical Policies & Clinical UM Guidelines

Other client policy sites:

Other Clinical Guidelines

Archived Guidelines

For guidelines older than 3 years, please contact AIM.guidelines@aimspecialtyhealth.com

Interventional Pain Management
Joint Surgery
  • Joint Surgery effective September 12, 2021 – September 10, 2022 for commercial, Medicare, and Medicaid (except Indiana)
  • Joint Surgery effective March 14, 2021 – September 11, 2021 for commercial and Medicare
  • Joint Surgery effective January 1, 2021 – September 11, 2021 for Medicaid (except Indiana); – November 6, 2021 for Indiana Medicaid
  • Joint Surgery effective January 1, 2021 – March 13, 2021 for commercial and Medicare
  • Joint Surgery effective May 17 – December 31, 2020 for commercial, September 26 – December 31, 2020 for Medicare
  • Joint Surgery effective June 29, 2019 – May 16, 2020 for commercial, – September 25, 2020 for Medicare, – December 31, 2020 for Medicaid
  • Joint Surgery effective March 9, 2019 – June 28, 2019
  • Joint Surgery effective January 1, 2019 – March 8, 2019
  • Joint Surgery effective November 1, 2017 – December 31, 2018
Small Joint Surgery
Spine Surgery
  • Spine Surgery effective June 12, 2022 – September 10, 2022 for commercial and Medicare
  • Spine Surgery effective January 1, 2022 – June 11, 2022 for commercial and Medicare; – September 10, 2022 for Medicaid (except Indiana)
  • Spine Surgery effective November 7, 2021 – December 31, 2021
  • Spine Surgery effective September 12, 2021 – November 6, 2021 for commercial, Medicare, and Medicaid (except Indiana)
  • Spine Surgery effective March 14, 2021– September 11, 2021; – November 6, 2021 for Indiana Medicaid
  • Spine Surgery effective January 1, 2021 – March 13, 2021
  • Spine Surgery effective May 17, 2020 – December 31, 2020
  • Spine Surgery effective February 9, 2020 – May 16, 2020
  • Spine Surgery effective January 1, 2020 – February 8, 2020
  • Spine Surgery effective May 18, 2019 – December 31, 2019
  • Spine Surgery effective March 9, 2019 – May 17, 2019
  • Spine Surgery effective January 1, 2019 – March 8, 2019
  • Spine Surgery effective July 1, 2018 – December 31, 2018
  • Spine Surgery effective November 1, 2017 – June 30, 2018
Sacroiliac Joint Fusion
Level of Care for Musculoskeletal Surgery and Procedures