As previously communicated in a Partners in Health UpdateSM article, as of July 1, 2019, AIM Specialty Health® (AIM) is using updated Clinical Appropriateness Guidelines for Advanced Imaging of the Heart for AmeriHealth members.
AmeriHealth has contracted with AIM to perform utilization management activities for outpatient non-emergent diagnostic imaging services and certain high-technology radiology services pertaining to the heart for our managed care members. AIM uses the Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to determine the medical necessity for these services. To view AIM’s current guidelines, go to the Resources section of AIM’s website.
Summary of the changes
As of July 1, 2019, the following changes were implemented to the Clinical Appropriateness Guidelines for Advanced Imaging of the Heart:
- Resting transthoracic echocardiography (TTE) and blood pool imaging
- Changes made to address frequency of surveillance of LV function for cardio-oncology.
- TTE
- Changes made to address frequency of surveillance echocardiography following transcatheter mitral valve repair. These recommendations follow the Centers for Medicare & Medicaid Services guidelines.
Policies and guidelines
The following policies were posted as Notifications on April 1, 2019, and are effective as of July 1, 2019. These policies include a list of procedure codes and a link to the cardiology guidelines on AIM’s website:
- AmeriHealth New Jersey: #09.00.46w: High-Technology Radiology Services (New Jersey)
- AmeriHealth Pennsylvania: #09.00.46w: High-Technology Radiology Services (Pennsylvania)
To access these medical policies, visit our Medical Policy Portal.