MUSCULOSKELETAL

Anthem Medical Policies for Musculoskeletal

Document # Medical Policy Title
SURG.00052 Intradiscal Annuloplasty Procedures (Percutaneous Intradiscal Electrothermal Therapy [IDET], Percutaneous Intradiscal Radiofrequency Thermocoagulation [PIRFT] and Intradiscal Biacuplasty [IDB])
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
SURG.00127 Sacroiliac Joint Fusion
TRANS.00035 Mesenchymal Stem Cell Therapy for Orthopedic Indications

 

AIM Clinical Guidelines for Musculoskeletal

Interventional Pain Management

For Commercial and Medicare members

OPEN THE GUIDELINES FOR PAIN MANAGEMENT EFFECTIVE AUGUST 16, 2020 FOR COMMERCIAL – SEPTEMBER 26 FOR MEDICARE

For Medicaid members

OPEN THE GUIDELINES FOR INTERVENTIONAL PAIN MANAGEMENT EFFECTIVE JANUARY 1, 2020 FOR MEDICAID

 

Joint Surgery

For Commercial and Medicare members

OPEN THE GUIDELINES FOR JOINT SURGERY EFFECTIVE MAY 17, 2020 FOR COMMERCIAL – SEPTEMBER 26, 2020 FOR MEDICARE

For Medicaid members

OPEN THE GUIDELINES FOR JOINT SURGERY EFFECTIVE JUNE 29, 2019 FOR MEDICAID

 

Small Joint Surgery

For Commercial members

OPEN THE GUIDELINES FOR SMALL JOINT SURGERY EFFECTIVE NOVEMBER 1, 2020

 

Spine Surgery

OPEN THE GUIDELINES FOR SPINE SURGERY EFFECTIVE MAY 17, 2020

 

Level of Care for Musculoskeletal Surgery and Procedures

OPEN THE GUIDELINES FOR LEVEL OF CARE EFFECTIVE NOVEMBER 1, 2020

 

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 Anthem 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 June 29, 2019 – May 16, 2020 for Commercial, – September 26 for Medicare members
  • 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
Spine Surgery
Level of Care for Musculoskeletal Surgery and Procedures