CLINICAL GUIDELINES MUSCULOSKELETAL

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 procedures and surgery are developed through a rigorous process integrating evidence-based literature with expert physician review. Included are guidelines for interventional pain management,  joint surgery, spine surgery, sacroiliac joint fusion, and level of care.

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 non-Anthem Medicaid members

OPEN THE INTERVENTIONAL PAIN MANAGEMENT GUIDELINES FOR COMMERCIAL/MEDICARE/NON-ANTHEM MEDICAID

For Anthem Medicaid members

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For commercial, Medicare, and Medicaid members

COMING SOON INTERVENTIONAL PAIN MANAGEMENT GUIDELINES EFFECTIVE APRIL 9, 2023

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 except Indiana Medicaid

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For Indiana Medicaid members

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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

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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 Medicaid members except Indiana Medicaid

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For Indiana Medicaid

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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 Medicaid members except Indiana Medicaid

OPEN THE GUIDELINES FOR SACROILIAC JOINT FUSION

For Indiana Medicaid

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AIM Clinical Appropriateness Guidelines for Level of Care 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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