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
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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
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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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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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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.