Effective July 1, 2019, AIM Specialty Health^® (AIM) will be 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 will use the updated Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to determine the medical necessity for these services. To view AIM’s current and future guidelines, go to the Resources section of AIM’s website.

Summary of the changes

Effective July 1, 2019, the following changes will be 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 will go into effect on July 1, 2019. These policies include a list of procedure codes and a link to current and future 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 view the Notifications for these policies, go to our Medical Policy Portal. Select Accept and Go to Medical Policy Online, then select Active Notifications.