AIM General Clinical Guideline
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AIM CLINICAL APPROPRIATENESS GUIDELINES FOR MUSCULOSKELETAL
The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines.
AIM Clinical Appropriateness Guidelines for Musculoskeletal are developed through a rigorous process integrating evidence-based literature with expert physician review. Guidelines for joint surgery, spine surgery, and interventional pain management are included below.
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 INTERVENTIONAL PAIN MANAGEMENT
The interventions addressed in the AIM Clinical Appropriateness Guidelines for Interventional Pain Management include epidural steroid injections; paravertebral facet injection, nerve block, and neurolysis; sacroiliac steroid injections; spinal cord stimulators; and regional sympathetic nerve block.
For commercial, Medicare, and Medicaid members
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For commercial, Medicare, and non-Anthem Medicaid members
COMING SOON INTERVENTIONAL PAIN MANAGEMENT GUIDELINES EFFECTIVE NOVEMBER 6, 2022
AIM CLINICAL APPROPRIATENESS GUIDELINES FOR JOINT SURGERY
The interventions addressed in the AIM Clinical Appropriateness Guidelines for Joint Surgery include total replacement of the hip, knee, and shoulder; arthroscopy of the hip, knee, and shoulder; treatment of osteochondral defects; and meniscal allograft transplantation.
For commercial, Medicare, and Medicaid members
OPEN THE GUIDELINES FOR JOINT SURGERY
For commercial, Medicare, and Medicaid members except Indiana Medicaid
COMING SOON JOINT SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022
AIM CLINICAL APPROPRIATENESS GUIDELINES FOR SMALL JOINT SURGERY
The interventions addressed in the AIM Clinical Appropriateness Guidelines for Small Joint Surgery include hallux rigidus surgery; hallux valgus and bunionette surgery; and treatment of lesser toe deformities and ankle arthritis.
For commercial members
OPEN THE GUIDELINES FOR SMALL JOINT SURGERY
COMING SOON SMALL JOINT SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022
AIM CLINICAL APPROPRIATENESS GUIDELINES FOR SPINE SURGERY
The interventions addressed in the AIM Clinical Appropriateness Guidelines for Spine Surgery include bone grafts, bone growth stimulators, foraminotomies, fusions, laminectomy, discectomy, disc arthroplasty, treatment of spinal deformity, and vertebroplasty and kyphoplasty.
For commercial, Medicare, and non-Anthem Medicaid members
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For Anthem Medicaid
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For commercial, Medicare, and Medicaid members except Indiana Medicaid
COMING SOON SPINE SURGERY GUIDELINES EFFECTIVE SEPTEMBER 11, 2022
AIM CLINICAL APPROPRIATENESS GUIDELINES FOR SACROILIAC JOINT FUSION
The intervention addressed in the AIM Clinical Appropriateness Guidelines for Sacroiliac Joint Fusion is the minimally invasive sacroiliac joint fusion with the IFuse system (titanium triangular implant).
For commercial, Medicare, and non-Anthem Medicaid members
OPEN THE SACROILIAC JOINT FUSION GUIDELINES FOR COMMERCIAL/MEDICARE/NON-ANTHEM MEDICAID
For Anthem Medicaid
OPEN THE SACROILIAC JOINT FUSION GUIDELINES FOR ANTHEM MEDICAID
For commercial, Medicare, and Medicaid members except Indiana Medicaid
COMING SOON SACROILIAC JOINT FUSION GUIDELINES EFFECTIVE SEPTEMBER 11, 2022
AIM LEVEL OF CARE GUIDELINES FOR MUSCULOSKELETAL SURGERY AND PROCEDURES
The Level of Care Guidelines for Musculoskeletal Surgery and Procedures are intended to assist in determining the appropriate level of care necessary to safely and effectively perform the requested surgical procedure.
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CLINICAL GUIDELINES ACCESS
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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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.