Effective July 1, 2019, AIM Specialty Health® (AIM) will be using updated
Clinical Appropriateness Guidelines for Radiology 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 for our managed care members. AIM will use the updated
Clinical Appropriateness Guidelines for Radiology to determine the medical necessity for these services. To view 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 Radiology:
-
Head and neck imaging
- Sinusitis/rhinosinusitis
- Infectious disease – not otherwise specified
- Inflammatory conditions – not otherwise specified
- Trauma
- Neck mass (including lymphadenopathy)
- Parathyroid adenoma
- Temporomandibular joint dysfunction
- Cerebrospinal fluid (CSF) leak of the skull base
- Dizziness or vertigo
- Hearing loss
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 radiology 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.