AIM General Clinical Guideline
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AIM Clinical Appropriateness Guidelines for Cardiology
The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines.
AIM Clinical Appropriateness Guidelines for Cardiology are developed through a rigorous process integrating evidence-based literature with expert physician review. Included are guidelines for imaging of the heart, diagnostic coronary angiography, percutaneous coronary intervention, cardiac resynchronization therapy, and implantable cardioverter defibrillators.
The Guidelines do not address coverage, benefit or other plan specific issues. Applicable federal and state coverage mandates take precedence over these clinical guidelines. If requested by a health plan, AIM will review requests based on health plan medical policy/guidelines in lieu of the AIM Guidelines.
AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart
Modalities addressed in the AIM Clinical Appropriateness Guidelines for Advanced Imaging of the Heart include echocardiography, nuclear cardiology, cardiac CT, cardiac MRI, and cardiac PET.
For commercial, Medicare, and Medicaid members except Simply Healthcare (Florida Medicaid)
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For Simply Healthcare (Florida Medicaid) members
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For commercial, Medicare, and non-Anthem Medicaid members
COMING SOON CARDIAC IMAGING GUIDELINES EFFECTIVE NOVEMBER 6, 2022
AIM Clinical Appropriateness Guidelines for Diagnostic Coronary Angiography
The procedures addressed in the AIM Clinical Appropriateness Guidelines for Diagnostic Coronary Angiography include catheter placement for visualization of native coronary arteries and/or bypass grafts, as well as left and/or right heart catheterization when performed with coronary angiography.
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For commercial, Medicare, and non-Anthem Medicaid members
COMING SOON DIAGNOSTIC CORONARY ANGIOGRAPHY GUIDELINES EFFECTIVE NOVEMBER 6, 2022
AIM Clinical Appropriateness Guidelines for Percutaneous Coronary Intervention
The procedures addressed in the AIM Clinical Appropriateness Guidelines for Percutaneous Coronary Intervention include balloon angioplasty, coronary stent placement, and coronary atherectomy.
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AIM Clinical Appropriateness Guidelines for Cardiac Resynchronization Therapy
The devices addressed in the AIM Clinical Appropriateness Guidelines for Cardiac Resynchronization Therapy include implantable cardiac resynchronization devices that perform pacing function and do not provide defibrillation.
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AIM Clinical Appropriateness Guidelines for Implantable Cardioverter Defibrillators
The devices addressed in the AIM Clinical Appropriateness Guidelines for Implantable Cardioverter Defibrillators include transvenous and subcutaneous implantable cardioverter defibrillators.
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AIM Clinical Appropriateness Guidelines for Arterial Ultrasound – Criteria moved effective November 10, 2019
Tests addressed in the AIM Clinical Appropriateness Guidelines for Arterial Ultrasound include physiologic testing and duplex ultrasounds of the upper and lower extremities, the extracranial vessels, and the aorta and inferior vena cava (IVC). Effective November 10, 2019, these tests will be addressed in the AIM Clinical Appropriateness Guidelines for Vascular Imaging.
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Accessing Clinical Guidelines and Cancer Treatment Pathways
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AIM Specialty Health® (AIM) has developed proprietary Clinical Guidelines and Cancer Treatment Pathways (together with any updates, referred to collectively as the “Guidelines and Pathways”). The Guidelines and Pathways are designed to evaluate and direct the appropriate utilization of certain health care services. They are based on data from peer-reviewed scientific literature, from criteria developed by specialty societies, and from guidelines adopted by other health care organizations. Access to these Guidelines and Pathways is being provided for informational purposes only. Although AIM has a process for updating its Guidelines and Pathways on a regular basis, due to the rapidly evolving nature of medicine, these Guidelines and Pathways may not reflect the most current evidence on a particular service or treatment.
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The Guidelines and Pathways do not constitute medical advice and/or medical care and do not guarantee results or outcomes. The Guidelines and Pathways are not a substitute for the experience and judgment of a physician or other health care professionals. Any clinician seeking to apply or consult the Guidelines or Pathways is expected to use independent medical judgment in the context of individual clinical circumstances to determine any patient’s care or treatment. The Guidelines and Pathways do not address coverage, benefit, or other plan specific issues.
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About the AIM Clinical Appropriateness Guidelines for Genetic Testing
The AIM Clinical Appropriateness Guidelines for Genetic Testing (with any updates, referred to as the “Genetic Testing Guidelines”) were developed by and used with permission from Informed Medical Decisions, Inc.
The Genetic Testing Guidelines are protected by copyright of Informed Medical Decisions, Inc., as permitted by and to the full extent of the law. These rights are not released, transferred, or assigned as a result of allowing access. You agree that you do not have any ownership rights to the Genetic Testing Guidelines and that you are expressly prohibited from selling, assigning, leasing, licensing, reproducing, or distributing the Genetic Testing Guidelines unless authorized in writing by Informed Medical Decisions.
AIM and Informed Medical Decisions, Inc., disclaim all responsibility for any consequences or liability attributable or related to any use, nonuse, or interpretation of information contained in the Genetic Testing Guidelines.