This version of the policy will become effective on 02/09/2020.
AIM Specialty Health® (AIM) has revised their Advanced Imaging Clinical Appropriateness Guidelines for Radiology and the Heart. These guidelines will become effective 02/09/2020. These guidelines are available online at:http://www.aimspecialtyhealth.com/CG-Radiology.html or http://www.aimspecialtyhealth.com/CG-Cardiology.html.
Note: on 01/02/2020 this policy Notification was updated to incorporate CPT coding updates effective 01/01/2020.
The following CPT codes have been added to the policy: 78429, 78430, 78431, 78432, 78433, & 78434 (Medically Necessary)
The following CPT codes have been deleted to the policy: 0482T
The following CPT codes have been revised in the policy: 78459, 78491, & 78492
The policy number was revised from 09.00.46y to 09.00,46z.
When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.
This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.
Policy: 09.00.02e:Electron Beam Computed Tomography (EBCT) for Screening Evaluations
Policy: 09.00.04k:Bone Mineral Density (BMD) Testing
Policy: 09.00.24c:Full-Body Computerized Tomography (CT) Scan Screening
Policy: 09.00.51a:Positron Emission Mammography (PEM)
Policy: 11.06.06e:Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation